Modulation of BCL11A for treatment of hemoglobinopathies

ABSTRACT

The invention relates to methods and uses of modulating fetal hemoglobin expression (HbF) in a hematopoietic progenitor cells via inhibitors of BCL11A expression or activity, such as RNAi and antibodies.

CROSS REFERENCE TO RELATED APPLICATIONS

This application is a continuation application of U.S. patentapplication Ser. No. 14/987,219 filed on Jan. 4, 2016, issued as U.S.Pat. No. 9,885,041 on Feb. 6, 2018, which is a continuation applicationof U.S. patent application Ser. No. 13/743,399 filed on Jan. 17, 2013,issued as U.S. Pat. No. 9,228,185 on Jan. 5, 2016, which is acontinuation application of U.S. patent application Ser. No. 13/063,524filed on Apr. 14, 2011, issued as U.S. Pat. No. 8,383,604 on Feb. 26,2013 and is a 35 U.S.C. § 371 National Phase Entry Application ofInternational Application No. PCT/US2009/056770 filed Sep. 14, 2009,which designates the U.S., and which claims benefit under 35 U. S. C. §119(e) of U.S. Provisional Application No. 61/097,017 filed on Sep. 15,2008 and U.S. Provisional Application No. 61/222,571 filed on Jul. 2,2009, the contents of each are incorporated herein by reference in theirentireties.

GOVERNMENT SUPPORT

This invention was made with Government Support under T32 GM07726, T32GM07753-27, 5P01 HL32262-26, and 5R01 HL32259-27, all awarded by theNational Institutes of Health. The Government has certain rights in theinvention.

SEQUENCE LISTING

The instant application contains a Sequence Listing which has beensubmitted in ASCII format via EFS-Web and is hereby incorporated byreference in its entirety. Said ASCII copy, created on Jan. 4, 2016, isnamed 20160104_SequenceListing-TextFile_701039_069896_C.txt and is 6,427bytes in size.

BACKGROUND OF THE INVENTION

Normal adult hemoglobin comprises four globin proteins, two of which arealpha (α) proteins and two of which are beta (β) proteins. Duringmammalian fetal development, particularly in humans, the fetus producesfetal hemoglobin, which comprises two gamma (γ)-globin proteins insteadof the two β-globin proteins. At some point during fetal development orinfancy, depending on the particular species and individual, a globinswitch occurs, referred to as the “fetal switch”, at which point,erythrocytes in the fetus switch from making predominantly γ-globin tomaking predominantly β-globin. The developmental switch from productionof predominantly fetal hemoglobin or HbF (α₂γ₂) to production of adulthemoglobin or HbA (α₂β₂) begins at about 28 to 34 weeks of gestation andcontinues shortly after birth until HbA becomes predominant. This switchresults primarily from decreased transcription of the gamma-globin genesand increased transcription of beta-globin genes. On average, the bloodof a normal adult contains only about 2% HbF, though residual HbF levelshave a variance of over 20 fold in healthy adults (Atweh, Semin.Hematol. 38(4):367-73 (2001)).

Hemoglobinopathies encompass a number of anemias of genetic origin inwhich there is a decreased production and/or increased destruction(hemolysis) of red blood cells (RBCs). These also include geneticdefects that result in the production of abnormal hemoglobins with aconcomitant impaired ability to maintain oxygen concentration. Some suchdisorders involve the failure to produce normal β-globin in sufficientamounts, while others involve the failure to produce normal β-globinentirely. These disorders associated with the β-globin protein arereferred to generally as β-hemoglobinopathies. For example,β-thalassemias result from a partial or complete defect in theexpression of the β-globin gene, leading to deficient or absent HbA.Sickle cell anemia results from a point mutation in the β-globinstructural gene, leading to the production of an abnormal (sickled)hemoglobin (HbS). HbS RBCs are more fragile than normal RBCs and undergohemolysis more readily, leading eventually to anemia (Atweh, Semin.Hematol. 38(4):367-73 (2001)).

Recently, the search for treatment aimed at reduction of globin chainimbalance in patients with β-hemoglobinopathies has focused on thepharmacologic manipulation of fetal hemoglobin (α2γ2; HbF). Thetherapeutic potential of such approaches is suggested by observations ofthe mild phenotype of individuals with co-inheritance of both homozygousβ-thalassemia and hereditary persistence of fetal hemoglobin (HPFH), aswell as by those patients with homozygous β°-thalassemia who synthesizeno adult hemoglobin, but in whom a reduced requirement for transfusionsis observed in the presence of increased concentrations of fetalhemoglobin. Furthermore, it has been observed that certain populationsof adult patients with β chain abnormalities have higher than normallevels of fetal hemoglobin (HbF), and have been observed to have amilder clinical course of disease than patients with normal adult levelsof HbF. For example, a group of Saudi Arabian sickle-cell anemiapatients who express 20-30% HbF have only mild clinical manifestationsof the disease (Pembrey, et al., Br. J. Haematol. 40: 415-429 (1978)).It is now accepted that hemoglobin disorders, such as sickle cell anemiaand the β-thalassemias, are ameliorated by increased HbF production.(Reviewed in Jane and Cunningham Br. J. Haematol. 102: 415-422 (1998)and Bunn, N. Engl. J. Med. 328: 129-131 (1993)).

As mentioned earlier, the switch from fetal hemoglobin to adulthemoglobin (α2γ2; HbA) usually proceeds within six months afterparturition. However, in the majority of patients withβ-hemoglobinopathies, the upstream γ globin genes are intact and fullyfunctional, so that if these genes become reactivated, functionalhemoglobin synthesis could be maintained during adulthood, and thusameliorate disease severity (Atweh, Semin. Hematol. 38(4):367-73(2001)). Unfortunately, the in vivo molecular mechanisms underlying theglobin switch are not well understood.

Evidence supporting the feasibility of reactivation of fetal hemoglobinproduction comes from experiments in which it was shown that peripheralblood, containing clonogenic cells, when given the appropriatecombination of growth factors, produce erythroid colonies and bursts insemisolid culture. Individual cells in such colonies can accumulatefetal hemoglobin (HbF), adult hemoglobin (HbA) or a combination of both.In cultures from adult blood, nucleated red cells accumulate either HbA(F−A+) only, or a combination of HbF and HbA (F+A+) (Papayannopoulou, etal., Science 199: 1349-1350 (1978); Migliaccio, et al., Blood 76:1150-1157 (1990)). Importantly, individual colonies contain both F+ andF− cells, indicating that both types are progeny from the samecirculating stem cells. Thus, during the early stages of development inculture, cells execute an option, through currently unknown mechanisms,whether or not to express HbF. The proportion of adult F+ cellsdeveloping in culture does not appear to be preprogrammed in vivo, butappears to depend on culture conditions: A shift into the combined HbFand HbA expression pathway can, for example, be achieved in vitro byhigh serum concentrations, due to the activity of an unidentifiedcompound that can be absorbed on activated charcoal (Bohmer, et al.,Prenatal Diagnosis 19: 628-636 (1999); Migliaccio, et al., Blood 76:1150 (1990); Rosenblum, et al., in: Experimental Approaches for theStudy of Hemoglobin 397 (1985)).

Overall, identification of molecules that play a role in the globinswitch is important for the development of novel therapeutic strategiesthat interfere with adult hemoglobin and induce fetal hemoglobinsynthesis. Such molecules would provide new targets for the developmentof therapeutic interventions for a variety of hemoglobinopathies inwhich reactivation of fetal hemoglobin synthesis would significantlyameliorate disease severity and morbidity.

SUMMARY OF THE INVENTION

The invention relates to methods and uses of modulating fetal hemoglobinexpression (HbF) via BCL11A.

The invention is based, in part, upon identification of a function forthe BCL11A protein, namely that the BCL11A protein acts as a stagespecific regulator of fetal hemoglobin expression.

Accordingly, the invention provides a method for increasing fetalhemoglobin levels in a cell, comprising the steps of contacting ahematopoietic progenitor cell with an effective amount of a compositioncomprising an inhibitor of BCL11A, whereby fetal hemoglobin expressionis increased in the hematopoietic progenitor cell, or its progeny,relative to the cell prior to contacting.

The hematopoietic progenitor cell is contacted ex vivo, in vitro, or invivo. In a further embodiment, the hematopoietic progenitor cell beingcontacted is of the erythroid lineage.

In one embodiment, the composition inhibits BCL11A expression. In oneembodiment, the inhibitor of BCL11A expression is selected from a smallmolecule and a nucleic acid. In a preferred embodiment, the inhibitor isa nucleic acid comprising a BCL11A specific RNA interference agent or avector encoding a BCL11A specific RNA interference agent. In a preferredembodiment, the RNA interference agent comprises one or more of thenucleotide sequences of SEQ ID NO: 1-6.

In one embodiment, the composition inhibits BCL11A activity. In oneembodiment, the inhibitor of BCL11A activity is selected from the groupconsisting of an antibody against BCL11A or an antigen-binding fragmentthereof, a small molecule, and a nucleic acid. In a more preferredembodiment, the nucleic acid is a BCL11A specific RNA interferenceagent, a vector encoding a RNA interference agent, or an aptamer thatbinds BCL11A. In a preferred embodiment, the RNA interference agentcomprises one or more of the nucleotide sequences of SEQ ID NO: 1-6.

Accordingly, the invention provides a method for increasing fetalhemoglobin levels in a mammal in need thereof, comprising the step ofcontacting a hematopoietic progenitor cell in the mammal with aneffective amount of a composition comprising an inhibitor of BCL11A,whereby fetal hemoglobin expression is increased in the mammal, relativeto expression prior to the contacting.

In one embodiment, the mammal has been diagnosed with ahemoglobinopathy. In a further embodiment, the hemoglobinopathy is aβ-hemoglobinopathy. In another embodiment, the hemoglobinopathy is asickle cell disease. The sickle cell disease can be sickle cell anemia,sickle-hemoglobin C disease (HbSC), sickle beta-plus-thalassaemia(HbS/3+) and sickle beta-zero-thalassaemia (HbS/β0). In anotherembodiment, the hemoglobinopathy is β-thalassemia.

In one embodiment, the hematopoietic progenitor cell is contacted withthe composition ex vivo or in vitro, and the cell or its progeny isadministered to the mammal. In a further embodiment, the hematopoieticprogenitor cell being contacted is of the erythroid lineage.

In one embodiment, the hematopoietic progenitor cell is contacted with acomposition comprising an inhibitor of BCL11A and a pharmaceuticallyacceptable carrier or diluent. In a further embodiment, the compositioncomprising a BCL11A inhibitor is administered by injection, infusion,instillation, or ingestion.

In one embodiment, the composition comprising a BCL11A inhibitorinhibits the expression of BCL11A. In another embodiment, the inhibitorof BCL11A expression is selected from a small molecule and a nucleicacid. In a preferred embodiment, the nucleic acid is a BCL11A specificRNA interference agent or a vector encoding a RNA interference agent, oran aptamer that binds BCL11A. In a preferred embodiment, the RNAinterference agent comprises one or more of the nucleotide sequences ofSEQ ID NO: 1-6.

In one embodiment, the composition comprising a BCL11A inhibitorinhibits the activity of BCL11A. In another embodiment, the inhibitor ofBCL11A activity is selected from the group consisting of an antibodyagainst BCL11A or an antigen-binding fragment thereof, a small molecule,and a nucleic acid. In a preferred embodiment, the nucleic acidinhibitor of BCL11A activity is a BCL11A specific RNA interferenceagent, a vector encoding a RNA interference agent, or an aptamer thatbinds BCL11A. In another embodiment, the RNA interference agentcomprises one or more of the nucleotide sequences of SEQ ID NO: 1-6.

Accordingly, the invention provides a method for identifying a modulatorof BCL11A activity or expression, the method comprising contacting ahematopoietic progenitor cell with a composition comprising a testcompound, and measuring the level of fetal hemoglobin or fetalhemoglobin mRNA in the hematopoietic progenitor cell or its progeny,wherein an increase in fetal hemoglobin is indicative that the testcompound is a candidate inhibitor of BCL11A activity or expression.

In one embodiment, the hematopoietic progenitor cell is contacted invivo, ex vivo, or in vitro. In one embodiment, the cell is of human,non-human primate, or mammalian origin. In one embodiment, the testcompound is a small molecule, antibody or nucleic acid. In a preferredembodiment, the composition causes an increase in fetal hemoglobinexpression.

BRIEF DESCRIPTION OF DRAWINGS

FIGS. 1A-1B show the expression of BCL11A in human erythroidprogenitors.

FIG. 1A shows the major BCL11A isoforms present in nuclear extracts ofhuman erythroid cells.

FIG. 1B compares the expression of BCL11A and fetal hemoglobin inerythroid cells at different stages of human ontogeny.

FIG. 2A demonstrates that the common variant rs4671393 is associatedwith BCL11A expression in human lymphoblastoid cell lines from theHapMap European (CEU) and African (YRI) populations.

FIG. 2B show Western blots of lysates of primary human bone marrow (BM)erythroblasts, second trimester fetal liver (FL) erythroblasts, firsttrimester circulating primitive erythroblasts, and K562 cells. Primaryhuman stage-matched erythroblasts were isolated by sorting for the CD235and CD71 double-positive population. The XL and L bands migrate togetherhere as a result of reduced separation on this blot.

FIGS. 3A-3D depict the proteomic affinity screen methodology used toidentify BCL11A partner proteins in erythroid cells.

FIG. 3A depicts the scheme used for affinity purification in mouseerythroleukemia (MEL) cells.

FIG. 3B tabulates the results of the subtractive screen.

FIG. 3C displays the results of the analyses of the Affymetrix arrays.

FIG. 3D highlights the motif found in BCL11A and several other proteinssuggested to mediate interactions with the NuRD repressor complex.

FIGS. 4A-4E show confirmations of the BCL11A interactions with GATA-1,FOG-1, and the NuRD complex in erythroid cells.

FIG. 4A shows immunoprecipitation data that confirms the interactions ofBCL11A with GATA-1, FOG-1, MTA2, and RBBP7 in erythroid (MEL) cells.

FIG. 4B depicts the interactions of BCL11A with MTA2, GATA-1, and FOG-1using gel filtration fractions from erythroid nuclear extracts.

FIGS. 4C and 4D show immunoprecipitation data that confirm theinteractions of BCL11A with GATA-land FOG-1 respectively by exogenousexpression in Cos7 cells.

FIG. 4E shows immunoprecipitation data to maps the interaction of BCL11Aon the GATA-1 molecule.

FIGS. 5A-5E demonstrate that BCL11A acts as a repressor of the γ-globingene.

FIG. 5A demonstrates that siRNA-mediated knockdown of BCL11A results inelevations of γ-globin mRNA levels in human erythroid progenitor cells.

FIG. 5B depicts that global gene expression is not modified greatly incells targeted with BCL11A siRNA.

FIG. 5C shows that lentiviral-mediated shRNA delivery to human erythroidprogenitors results in a 60%-97% knockdown.

FIG. 5D depicts that the shRNA targeted cells are morphologicallyindistinguishable from control treated cells.

FIG. 5E shows the induction of γ-globin mRNA in cells in response toknockdown of BCL11A.

FIG. 5F shows the hemolysates prepared from cells on day 12 ofdifferentiation show the presence of mature HbF.

FIGS. 6A-6H show that human γ-globin is primarily expressed in primitiveerythroid cells of β-locus mice.

FIG. 6A is a representative FACS plot showing FSC (linear scale) versusSSC (log scale) for E13.5 embryonic blood. Gating is shown to allow forthe enrichment of primitive and definitive lineages.

FIG. 6B is a histogram showing the relative expression of murine εγglobin gene, human embryonic ε gene, and human γ-globin genes in theprimitive population (P), as compared with the definitive population(D). Results are shown as mean±standard deviation (n>3 per group).P=0.98 for a two-sided t-test comparing the relative enrichment of εγwith γ-globin.

FIGS. 6C-6H are representatives immunohistochemical staining with ananti-HbF antibody from human and murine E13.5 fetal livers. All imagesare taken with a 60× objective.

FIG. 6C shows human fetal livers contain numerous erythroblasts, whichall stain positive for γ-globin expression.

FIGS. 6D and 6E show that murine fetal liver definitive erythroblasts donot show major γ-globin staining and only occasional cells withmegaloblastic primitive morphology show staining (arrows).

FIGS. 6E and 6F show many megaloblastic primitive cells in thecirculation having highly positive staining (arrowheads in FIG. 6E;arrows in FIG. 6F), while smaller definitive erythrocytes are negative(in FIG. 6F as smaller light grey circles).

FIGS. 6G and 6H show staining performed on the single copy YAC lines A20and A858 showed similar staining patterns. Positive staining wasdetermined in comparison with background staining from transgenenegative littermate controls.

FIGS. 7A-7D show PT-FISH analyses revealing that γ-globin expressionparallels the murine embryonic globins in primitive erythroid cells. Twoindependent lines of transgenic YAC mice, A85 (FIGS. 7A and 7C) and A20(FIGS. 7B and 7D) were analysed using four color primary transcript RNAfluorescence in situ hybridization (PT-FISH). For the first set ofexperiments, probes were made to target murine α-globin (ma), humanβ-globin (hβ), and human γ-globin (hγ). Additionally, DAPI was used toidentify nuclei of cells.

FIGS. 7A and 7B show the expression of γ-globin predominates within thetwo lines in the primitive populations seen circulating in primitiveblood cells (PBC) from embryos E1 1.5 and E13.5. Minor expression isseen in the mature definitive populations from fetal liver (FL) atE13.5. Many of these cells may represent primitive cells found withinthe FL parenchyma.

FIGS. 7C and 7D show a parallel expression of mεy and hγ for PBC atE13.5 and FL at E13.5, respectively. The graphs depict the percentage ofactive loci and are measured for ≥100 nuclei per probe set at each timepoint.

FIGS. 8A-8B show that BCL11A expression varies between humans and mice,indicating a model for trans-acting variation in β-globin geneexpression.

FIG. 8A shows that in human cells full-length proteins of BCL11A (XL/Lisoforms) are reduced within cell populations that express high levelsof γ-globin, including primitive and fetal liver cells.

FIG. 8B is a schematic model summarizes the ontogeny of β-like globingene regulation in humans, mice, and β-locus mice. The ontogeny ofmammalian erythropoiesis and progenitor populations is shown at the top.Progenitor populations, including primitive erythroid populations(EryP-CFC), definitive hematopoietic stem cells (HSC), and definitiveerythroid burst-forming unit cells (BFU-E) are depicted. The aortogonado-mesonephros (AGM) and placenta are sites of definitivehematopoiesis. The patterns of β-like globin and BCL11A expression seenin the two species are shown below.

FIGS. 9A-9F shows that BCL11A−/− mice fail to silence expression ofmouse embryonic β-like globins and human β-globin genes.

FIG. 9A shows that he CD71/Ter119 expression pattern for fetal livercells from E14.5 embryos, revealing grossly normal erythropoiesis withthese phenotypic markers. The mean percentages for the populations ineach quadrant are shown in red (n=6 for fl/+ controls and n=4 for −/−mutants). The P>0.1 by a two-sided t-test for all gated populationsanalyzed.

FIG. 9B shows that the expression of the embryonic globins as apercentage of total mouse β-like globins for control mice (fl/+), BCL11Aheterozygous (+/−), and null mice (−/−) at E14.5 (n=10, 14, 11respectively).

FIG. 9C shows that the expression of the embryonic globins as apercentage of total mouse β-like globins at E18.5 (n=9, 9, 7respectively).

FIG. 9D shows the immunohistochemistry was performed on E14.5 FLs fromBCL11A fl/+ and −/− animals for the embryonic globin εγ. Representativesections at 40× magnification with a 10× objective lens are shown.

FIG. 9E shows similar IHC staining was performed for βh1 globin. In bothcases robust expression is seen in the scattered erythroblasts of the FLin −/−, but not control mice.

FIG. 9F shows the expression of human β-globin locus genes for animalswith the various BCL1 1A genotypes in the presence of the β-locus YACtransgene (YAC+) at E14.5 (n=4, 6, 4 for the fl/+, +/−, and −/− animals,respectively) and E18.5 (n=4, 7, 4). All γ- and β-globin levels for thedifferent genotypes are significantly different (P<1×10⁻⁵ by a two-sidedt-test). All data are plotted as the mean±the standard deviation of themeasurement.

FIG. 10 shows the inability to recapitulate stress responses in adultβ-YAC mice. Adult β-locus mice were induced with a variety of γ-globinstimulating responses.

FIG. 11 shows that BCL11A RNA is expressed in mouse definitive cells,but not primitive cells.

FIGS. 12A and 12B show that BCL11A−/− mice are morphologically normaland completely lack BCL1 1A protein expression in the fetal liver.

FIG. 12A are examples of control (fl/+) and mutant mice (−/−) from thesame litter at E18.5. Mice were obtained in expected Mendelian ratios atE18.5 and the mutants were morphologically indistinguishable fromcontrol littermates.

FIG. 12B are protein expression of BCL1 1A data assessed in E18.5 fetallivers and showed reduced expression in heterozygous animals, withabsent expression in null animals. GAPDH was analyzed as a loadingcontrol.

FIG. 13 shows that BCL11A−/− mice have normal phenotypic erythropoiesisat E18.5. Erythroid maturation was assessed using the markers CD71 andTer-1 19 in the fetal livers of E18.5 animals (Sankaran, V. G., et al.,2008, Genes Dev 22, 463-475). The mean values in each quadrant are shown(n=9 for the controls and 7 for the null animals).

FIG. 14 shows that BCL11A−/− mice have normal erythroid morphology.Example cytospin preparations from single cell suspensions of the fetalliver stained with May-Grünwald-Giemsa stain are shown from E14.5 andE18.5. All images were viewed with a 10× objective and with the lensmagnifications shown.

FIGS. 15A and 15B are histological analyses of fetal livers from BCL11A−/− mice revealing normal gross histology and morphologicalerythropoiesis.

FIG. 15A shows saggital sections are shown at low resolution and showthat there are no gross histological abnormalities seen in these mice(at 5× magnification).

FIG. 15B shows histological sections stained with hematoxylin and eosin(H&E) are shown at two magnifications (10× objective with a 40× lens)from E14.5 and E18.5 fetal livers. These sections reveal clusters oferythroblasts within the fetal liver that appear to be similar inquantity and morphologically normal.

FIGS. 16A and 16B show that BCL1 1A−/− have an upregulation of embryonicglobins in the fetal liver.

FIG. 16A shows the relative RNA expression of the β-like globin genes isshown for controls (BCL11A fl/+), heterozygous animals (BCL11A−/+), andnull animals (BCL11A−/−) at E14.5 (n=10, 14, 11 for these groups,respectively). Additionally, the relative expression of BCL11A RNA isshown. The relative expression is normalized with respect to GAPDH (withGAPDH set to a value of 1). All data is shown as the mean±the standarderror of the measurement.

FIG. 16B shows the relative RNA expression (normalized to GAPDH) of theβ-like globin genes for controls, heterozygous animals, and null animalsat E18.5 (n=9, 9, 7 for these groups, respectively). All data is shownas the mean±the standard deviation.

FIG. 17 is the immunohistochemistry of BCL1 1A−/− mice showing anupregulation of embryonic globins in the fetal liver.Immunohistochemistry was performed on E18.5 FLs from BCL11A fl/+ and −/−animals for the embryonic globin βh1. Representative sections at 40×magnification with a 10× objective lens are shown. Similar IHC stainingwas performed for εγ globin as labeled in the figure.

FIG. 18A displays the percentages for all the human β-like globingenes±the standard deviation at E14.5 in β-Locus mice crosses withBCL11A mutant mice.

FIG. 18B displays the percentages for all the human β-like globingenes±the standard deviation at E18.5, in β-Locus mice crosses withBCL11A mutant mice. All γ- and β-globin levels for the differentgenotypes are significantly different (P<1×10⁻⁵ by a two-sided t-test).

FIG. 19 show that BCL11A occupies discrete regions in the human β-globinlocus in adult erythroid progenitors. The human β-globin locus isdepicted at the top with regions showing significant binding shaded ingray in the histogram plot below. The results are depicted as the meanwith the standard deviation as error bars (n=3 per group).

DETAILED DESCRIPTION OF THE INVENTION

The present invention provides for novel methods for the regulation offetal hemoglobin (HbF) synthesis for the treatment ofβ-hemoglobinopathies and screening methods therein.

The invention is based upon identification of a novel function for theBCL11A protein, namely that the BCL11A protein acts as a stage specificregulator of fetal hemoglobin expression and that expression of BCL11Arepresses γ-globin induction. Accordingly, the invention provides novelmethods for the regulation of γ-globin expression in erythroid cells.More specifically, these activities can be harnessed in methods for thetreatment of β-hemoglobinopathies by induction of γ-globin viainhibition of the BCL11A gene product.

Fetal hemoglobin (HbF) is a tetramer of two adult α-globin polypeptidesand two fetal β-like γ-globin polypeptides. During gestation, theduplicated γ-globin genes constitute the predominant genes transcribedfrom the β-globin locus. Following birth, γ-globin becomes progressivelyreplaced by adult β-globin, a process referred to as the “fetal switch”(3). The molecular mechanisms underlying this switch have remainedlargely undefined and have been a subject of intense research. Thedevelopmental switch from production of predominantly fetal hemoglobinor HbF (α₂γ₂) to production of adult hemoglobin or HbA (α₂β₂) begins atabout 28 to 34 weeks of gestation and continues shortly after birth atwhich point HbA becomes predominant. This switch results primarily fromdecreased transcription of the gamma-globin genes and increasedtranscription of beta-globin genes. On average, the blood of a normaladult contains only about 2% HbF, though residual HbF levels have avariance of over 20 fold in healthy adults (Atweh, Semin. Hematol.38(4):367-73 (2001)).

Hemoglobinopathies encompass a number of anemias of genetic origin inwhich there is a decreased production and/or increased destruction(hemolysis) of red blood cells (RBCs). These disorders also includegenetic defects that result in the production of abnormal hemoglobinswith a concomitant impaired ability to maintain oxygen concentration.Some such disorders involve the failure to produce normal β-globin insufficient amounts, while others involve the failure to produce normalβ-globin entirely. These disorders specifically associated with theβ-globin protein are referred to generally as β-hemoglobinopathies. Forexample, β-thalassemias result from a partial or complete defect in theexpression of the β-globin gene, leading to deficient or absent HbA.Sickle cell anemia results from a point mutation in the β-globinstructural gene, leading to the production of an abnormal (sickled)hemoglobin (HbS). HbS RBCs are more fragile than normal RBCs and undergohemolysis more readily, leading eventually to anemia (Atweh, Semin.Hematol. 38(4):367-73 (2001)). Moreover, the presence of a BCL11Agenetic variant, HBS1L-MYB variation, ameliorates the clinical severityin beta-thalassemia. This variant has been shown to be associated withHbF levels. Here, it was shown that there is an odds ratio of 5 forhaving a less severe form of beta-thalassemia with the high-HbF variant(Galanello S. et al., 2009, Blood, in press).

Recently, the search for treatment aimed at reduction of globin chainimbalance in patients with β-hemoglobinopathies has focused on thepharmacologic manipulation of fetal hemoglobin (α2γ2; HbF). Theimportant therapeutic potential of such approaches is suggested byobservations of the mild phenotype of individuals with co-inheritance ofboth homozygous β-thalassemia and hereditary persistence of fetalhemoglobin (HPFH), as well as by those patients with homozygousβ°-thalassemia who synthesize no adult hemoglobin, but in whom a reducedrequirement for transfusions is observed in the presence of increasedconcentrations of fetal hemoglobin. Furthermore, it has been observedthat certain populations of adult patients with β chain abnormalitieshave higher than normal levels of fetal hemoglobin (HbF), and have beenobserved to have a milder clinical course of disease than patients withnormal adult levels of HbF. For example, a group of Saudi Arabiansickle-cell anemia patients who express 20-30% HbF have only mildclinical manifestations of the disease (Pembrey, et al., Br. J.Haematol. 40: 415-429 (1978)). It is now accepted thatβ-hemoglobinopathies, such as sickle cell anemia and the β-thalassemias,are ameliorated by increased HbF production. (Reviewed in Jane andCunningham Br. J. Haematol. 102: 415-422 (1998) and Bunn, N. Engl. J.Med. 328: 129-131 (1993)).

While the molecular mechanisms controlling the in vivo developmentalswitch from γ- to β-globin gene expression are currently unknown, thereis accumulating evidence that external factors can influence γ-globingene expression. The first group of compounds discovered having HbFreactivation activity were cytotoxic drugs. The ability to cause de novosynthesis of HbF by pharmacological manipulation was first shown using5-azacytidine in experimental animals (DeSimone, Proc Natl Acad Sci USA.79(14):4428-31 (1982)). Subsequent studies confirmed the ability of5-azacytidine to increase HbF in patients with β-thalassemia and sicklecell disease (Ley, et al., N. Engl. J. Medicine, 307: 1469-1475 (1982),and Ley, et al., Blood 62: 370-380 (1983)). Additional experimentsdemonstrated that baboons treated with cytotoxic doses ofarabinosylcytosine (ara-C) responded with striking elevations ofF-reticulocytes (Papayannopoulou et al., Science. 224(4649):617-9(1984)), and that treatment with hydroxyurea led to induction ofγ-globin in monkeys or baboons (Letvin et. al., N Engl J Med.310(14):869-73 (1984)).

The second group of compounds investigated for the ability to cause HbFreactivation activity was short chain fatty acids. The initialobservation in fetal cord blood progenitor cells led to the discoverythat γ-aminobutyric acid can act as a fetal hemoglobin inducer (Perrineet al., Biochem Biophys Res Commun. 148(2):694-700 (1987)). Subsequentstudies showed that butyrate stimulated globin production in adultbaboons (Constantoulakis et al., Blood. December; 72(6):1961-7 (1988)),and it induced γ-globin in erythroid progenitors in adult animals orpatients with sickle cell anemia (Perrine et al., Blood. 74(1):454-9(1989)). Derivatives of short chain fatty acids such as phenylbutyrate(Dover et al., Br J Haematol. 88(3):555-61 (1994)) and valproic acid(Liakopoulou et al., 1: Blood. 186(8):3227-35 (1995)) also have beenshown to induce HbF in vivo. Given the large number of short chain fattyacid analogs or derivatives of this family, there are a number ofpotential compounds of this family more potent than butyrate.Phenylacetic and phenylalkyl acids (Torkelson et al., Blood Cells MolDis. 22(2):150-8. (1996)), which were discovered during subsequentstudies, were considered potential HbF inducers as they belonged to thisfamily of compounds. Presently, however, the use of butyrate or itsanalogs in sickle cell anemia and β-thalassemia remains experimental andcannot be recommended for treatment outside of clinical trials.

Clinical trials aimed at reactivation of fetal hemoglobin synthesis insickle cell anemia and β-thalassemia have included short term and longterm administration of such compounds as 5-azacytidine, hydroxyurea,recombinant human erythropoietin, and butyric acid analogs, as well ascombinations of these agents. Following these studies, hydroxyurea wasused for induction of HbF in humans and later became the first and onlydrug approved by the Food and Drug Administration (FDA) for thetreatment of hemoglobinopathies. However, varying drawbacks havecontraindicated the long term use of such agents or therapies, includingunwanted side effects and variability in patient responses. For example,while hydroxyurea stimulates HbF production and has been shown toclinically reduce sickling crisis, it is potentially limited bymyelotoxicity and the risk of carcinogenesis. Potential long termcarcinogenicity would also exist in 5-azacytidine-based therapies.Erythropoietin-based therapies have not proved consistent among a rangeof patient populations. The short half-lives of butyric acid in vivohave been viewed as a potential obstacle in adapting these compounds foruse in therapeutic interventions. Furthermore, very high dosages ofbutyric acid are necessary for inducing γ-globin gene expression,requiring catheritization for continuous infusion of the compound.Moreover, these high dosages of butyric acid can be associated withneurotoxicity and multiorgan damage (Blau, et al., Blood 81: 529-537(1993)). While even minimal increases in HbF levels are helpful insickle cell disease, β-thalassemias require a much higher increase thatis not reliably, or safely, achieved by any of the currently used agents(Olivieri, Seminars in Hematology 33: 24-42 (1996)).

Identifying natural regulators of HbF induction and production couldprovide a means to devise therapeutic interventions that overcome thevarious drawbacks of the compounds described above. Recent genome-wideassociation studies have yielded insights into the genetic basis ofnumerous complex diseases and traits (McCarthy et al., Nat Rev Genet 9,356 (2008) and Manolio et. al. J Clin Invest 118, 1590 (2008)). However,in the vast majority of instances, the functional link between a geneticassociation and the underlying pathophysiology remains to be uncovered.The level of fetal hemoglobin (HbF) is inherited as a quantitative traitand clinically important, given its above-mentioned andwell-characterized role in ameliorating the severity of the principalβ-hemoglobinopathies, sickle cell disease and β-thalassemia (Nathan et.al., Nathan and Oski's hematology of infancy and childhood ed. 6th, pp.2 v. (xiv, 1864, xli p.) 2003)). Two genome-wide association studieshave identified three major loci containing a set of five common singlenucleotide polymorphisms (SNPs) that account for ˜20% of the variationin HbF levels (Lettre et al., Proc Natl Acad Sci USA (2008); Uda et al.,Proc Natl Acad Sci USA 105, 1620 (2008); Menzel et al., Nat Genet 39,1197 (2007)). Moreover, several of these variants appear to predict theclinical severity of sickle cell disease (Lettre et al., Proc Natl AcadSci USA (2008)) and at least one of these SNPs may also affect clinicaloutcome in β-thalassemia (Uda et al., Proc Natl Acad Sci USA 105, 1620(2008)). The SNP with the largest effect size, explaining over 10% ofthe variation in HbF, is located in the second intron of a gene onchromosome 2, BCL11A. Whereas BCL11A, a C2H2-type zinc fingertranscription factor, has been investigated for its role in lymphocytedevelopment (Liu et al., Nat Immunol 4, 525 (2003) and Liu et al., MolCancer 5, 18 (2006)), its role in red blood cell production or globingene regulation has not been previously assessed.

At the onset of the recombinant DNA era, studies of globin genestructure provided a strong molecular foundation for interrogating thefetal globin switch. Considerable effort has focused on delineating thecis-elements within the β-globin locus necessary for proper regulationof the genes within the β-like globin cluster. These studies relied onnaturally occurring mutations and deletions that dramatically influenceHbF levels in adults, and have been complemented by generation oftransgenic mice harboring portions of the cluster (Nathan et. al.,Nathan and Oski's hematology of infancy and childhood ed. 6th, pp. 2 v.(xiv, 1864, xli p.) 2003) and G. Stamatoyannopoulos, Exp Hematol 33, 259(2005)). Although the precise cis-elements required for globin switchingremain ill-defined, findings in transgenic mice have strongly indicatedthat the γ-globin genes are autonomously silenced in the adult stage, afinding that is most compatible with the absence of fetal-stage specificactivators or the presence of a stage-specific repressor. The results ofrecent genetic association studies provide candidate genes tointerrogate for their involvement in control of the γ-globin genes, suchas BCL11A.

We identified a novel stage-specific repressor of the γ-globin genes,namely BCL11A, wherein the expression of the BCL11A protein acts as anegative regulator of expression from the γ-globin genes.

Methods of Increasing Fetal Hemoglobin in a Cell

The present invention provides improved methods for increasing fetalhemoglobin production in a cell, by the administration of compositionscontaining inhibitors of BCL11A. The data demonstrate that inhibition ofBCL11A leads to increased expression from the γ-globin genes, and agentswherein to achieve this inhibition.

As disclosed herein, it is an object of the present invention to providea method for increasing fetal hemoglobin levels in a cell.

Accordingly, one aspect of the invention provides a method forincreasing fetal hemoglobin levels expressed by a cell, comprising thesteps of contacting a hematopoietic progenitor cell with an effectiveamount of a composition comprising an inhibitor of BCL11A, whereby fetalhemoglobin expression is increased in the cell, or its progeny, relativeto the cell prior to such contacting.

In connection with contacting a cell with an inhibitor of BCL11A,“increasing the fetal hemoglobin levels” in a cell indicates that fetalhemoglobin is at least 5% higher in populations treated with a BCL11Ainhibitor, than in a comparable, control population, wherein no BCL11Ainhibitor is present. It is preferred that the percentage of fetalhemoglobin expression in a BCL11A inhibitor treated population is atleast 10% higher, at least 20% higher, at least 30% higher, at least 40%higher, at least 50% higher, at least 60% higher, at least 70% higher,at least 80% higher, at least 90% higher, at least 1-fold higher, atleast 2-fold higher, at least 5-fold higher, at least 10 fold higher, atleast 100 fold higher, at least 1000-fold higher, or more than a controltreated population of comparable size and culture conditions. The term“control treated population” is used herein to describe a population ofcells that has been treated with identical media, viral induction,nucleic acid sequences, temperature, confluency, flask size, pH, etc.,with the exception of the addition of the BCL11A inhibitor.

An “inhibitor” of BCL11A, as the term is used herein, can function in acompetitive or non-competitive manner, and can function, in oneembodiment, by interfering with the expression of the BCL11A protein.Any of a number of different approaches can be taken to inhibit BCL11Aexpression or activity. A BCL11A inhibitor includes any chemical orbiological entity that, upon treatment of a cell, results in inhibitionof the biological activity caused by activation of BCL11A in response tocellular signals. BCL11A inhibitors, include, but are not limited to,small molecules, antibodies or antigen-binding antibody fragments,intrabodies, aptamers, antisense constructs, RNA interference agents,and ribozymes.

Antibody Inhibitors of BCL11A

Antibodies that specifically bind BCL11A can be used for the inhibitionof the factor in vivo. Antibodies to BCL11A are commercially availableand can be raised by one of skill in the art using well known methods.The BCL11A inhibitory activity of a given antibody, or, for that matter,any BCL11A inhibitor, can be assessed using methods known in the art ordescribed herein—to avoid doubt, an antibody that inhibits BCL11A willcause an increase in fetal hemoglobin expression. Antibody inhibitors ofBCL11A can include polyclonal and monoclonal antibodies andantigen-binding derivatives or fragments thereof. Well known antigenbinding fragments include, for example, single domain antibodies (dAbs;which consist essentially of single VL or VH antibody domains), Fvfragment, including single chain Fv fragment (scFv), Fab fragment, andF(ab′)2 fragment. Methods for the construction of such antibodymolecules are well known in the art.

Nucleic Acid Inhibitors of BCL11A Expression

A powerful approach for inhibiting the expression of selected targetpolypeptides is through the use of RNA interference agents. RNAinterference (RNAi) uses small interfering RNA (siRNA) duplexes thattarget the messenger RNA encoding the target polypeptide for selectivedegradation. siRNA-dependent post-transcriptional silencing of geneexpression involves cleaving the target messenger RNA molecule at a siteguided by the siRNA. “RNA interference (RNAi)” is an evolutionallyconserved process whereby the expression or introduction of RNA of asequence that is identical or highly similar to a target gene results inthe sequence specific degradation or specific post-transcriptional genesilencing (PTGS) of messenger RNA (mRNA) transcribed from that targetedgene (see Coburn, G. and Cullen, B. (2002) J. of Virology 76(18):9225),thereby inhibiting expression of the target gene. In one embodiment, theRNA is double stranded RNA (dsRNA). This process has been described inplants, invertebrates, and mammalian cells. In nature, RNAi is initiatedby the dsRNA-specific endonuclease Dicer, which promotes processivecleavage of long dsRNA into double-stranded fragments termed siRNAs.siRNAs are incorporated into a protein complex (termed “RNA inducedsilencing complex,” or “RISC”) that recognizes and cleaves target mRNAs.RNAi can also be initiated by introducing nucleic acid molecules, e.g.,synthetic siRNAs or RNA interfering agents, to inhibit or silence theexpression of target genes. As used herein, “inhibition of target geneexpression” includes any decrease in expression or protein activity orlevel of the target gene or protein encoded by the target gene ascompared to a situation wherein no RNA interference has been induced.The decrease will be of at least 10%, 20%, 30%, 40%, 50%, 60%, 70%, 80%,90%, 95% or 99% or more as compared to the expression of a target geneor the activity or level of the protein encoded by a target gene whichhas not been targeted by an RNA interfering agent.

The terms “RNA interference agent” and “RNA interference” as they areused herein are intended to encompass those forms of gene silencingmediated by double-stranded RNA, regardless of whether the RNAinterfering agent comprises an siRNA, miRNA, shRNA or otherdouble-stranded RNA molecule. “Short interfering RNA” (siRNA), alsoreferred to herein as “small interfering RNA” is defined as an RNA agentwhich functions to inhibit expression of a target gene, e.g., by RNAi.An siRNA may be chemically synthesized, may be produced by in vitrotranscription, or may be produced within a host cell. In one embodiment,siRNA is a double stranded RNA (dsRNA) molecule of about 15 to about 40nucleotides in length, preferably about 15 to about 28 nucleotides, morepreferably about 19 to about 25 nucleotides in length, and morepreferably about 19, 20, 21, 22, or 23 nucleotides in length, and maycontain a 3′ and/or 5′ overhang on each strand having a length of about0, 1, 2, 3, 4, or 5 nucleotides. The length of the overhang isindependent between the two strands, i.e., the length of the overhang onone strand is not dependent on the length of the overhang on the secondstrand. Preferably the siRNA is capable of promoting RNA interferencethrough degradation or specific post-transcriptional gene silencing(PTGS) of the target messenger RNA (mRNA).

siRNAs also include small hairpin (also called stem loop) RNAs (shRNAs).In one embodiment, these shRNAs are composed of a short (e.g., about 19to about 25 nucleotide) antisense strand, followed by a nucleotide loopof about 5 to about 9 nucleotides, and the analogous sense strand.Alternatively, the sense strand may precede the nucleotide loopstructure and the antisense strand may follow. These shRNAs may becontained in plasmids, retroviruses, and lentiviruses and expressedfrom, for example, the pol III U6 promoter, or another promoter (see,e.g., Stewart, et al. (2003) RNA April; 9(4):493-501, incorporated byreference herein in its entirety). The target gene or sequence of theRNA interfering agent may be a cellular gene or genomic sequence, e.g.the BCL11A sequence. An siRNA may be substantially homologous to thetarget gene or genomic sequence, or a fragment thereof. As used in thiscontext, the term “homologous” is defined as being substantiallyidentical, sufficiently complementary, or similar to the target mRNA, ora fragment thereof, to effect RNA interference of the target. Inaddition to native RNA molecules, RNA suitable for inhibiting orinterfering with the expression of a target sequence include RNAderivatives and analogs. Preferably, the siRNA is identical to itstarget. The siRNA preferably targets only one sequence. Each of the RNAinterfering agents, such as siRNAs, can be screened for potentialoff-target effects by, for example, expression profiling. Such methodsare known to one skilled in the art and are described, for example, inJackson et al. Nature Biotechnology 6:635-637, 2003. In addition toexpression profiling, one may also screen the potential target sequencesfor similar sequences in the sequence databases to identify potentialsequences which may have off-target effects. For example, according toJackson et al. (Id.), 15, or perhaps as few as 11 contiguousnucleotides, of sequence identity are sufficient to direct silencing ofnon-targeted transcripts. Therefore, one may initially screen theproposed siRNAs to avoid potential off-target silencing using thesequence identity analysis by any known sequence comparison methods,such as BLAST. siRNA sequences are chosen to maximize the uptake of theantisense (guide) strand of the siRNA into RISC and thereby maximize theability of RISC to target human GGT mRNA for degradation. This can beaccomplished by scanning for sequences that have the lowest free energyof binding at the 5′-terminus of the antisense strand. The lower freeenergy leads to an enhancement of the unwinding of the 5′-end of theantisense strand of the siRNA duplex, thereby ensuring that theantisense strand will be taken up by RISC and direct thesequence-specific cleavage of the human BCL11A mRNA. siRNA moleculesneed not be limited to those molecules containing only RNA, but, forexample, further encompasses chemically modified nucleotides andnon-nucleotides, and also include molecules wherein a ribose sugarmolecule is substituted for another sugar molecule or a molecule whichperforms a similar function. Moreover, a non-natural linkage betweennucleotide residues can be used, such as a phosphorothioate linkage. TheRNA strand can be derivatized with a reactive functional group of areporter group, such as a fluorophore. Particularly useful derivativesare modified at a terminus or termini of an RNA strand, typically the 3′terminus of the sense strand. For example, the 2′-hydroxyl at the 3′terminus can be readily and selectively derivatizes with a variety ofgroups. Other useful RNA derivatives incorporate nucleotides havingmodified carbohydrate moieties, such as 2′O-alkylated residues or2′-O-methyl ribosyl derivatives and 2′-O-fluoro ribosyl derivatives. TheRNA bases may also be modified. Any modified base useful for inhibitingor interfering with the expression of a target sequence may be used. Forexample, halogenated bases, such as 5-bromouracil and 5-iodouracil canbe incorporated. The bases may also be alkylated, for example,7-methylguanosine can be incorporated in place of a guanosine residue.Non-natural bases that yield successful inhibition can also beincorporated. The most preferred siRNA modifications include2′-deoxy-2′-fluorouridine or locked nucleic acid (LAN) nucleotides andRNA duplexes containing either phosphodiester or varying numbers ofphosphorothioate linkages. Such modifications are known to one skilledin the art and are described, for example, in Braasch et al.,Biochemistry, 42: 7967-7975, 2003. Most of the useful modifications tothe siRNA molecules can be introduced using chemistries established forantisense oligonucleotide technology. Preferably, the modificationsinvolve minimal 2′-O-methyl modification, preferably excluding suchmodification. Modifications also preferably exclude modifications of thefree 5′-hydroxyl groups of the siRNA. The Examples herein providespecific examples of RNA interfering agents, such as shRNA moleculesthat effectively target BCL11A mRNA.

In a preferred embodiment, the RNA interference agent is delivered oradministered in a pharmaceutically acceptable carrier. Additionalcarrier agents, such as liposomes, can be added to the pharmaceuticallyacceptable carrier. In another embodiment, the RNA interference agent isdelivered by a vector encoding small hairpin RNA (shRNA) in apharmaceutically acceptable carrier to the cells in an organ of anindividual. The shRNA is converted by the cells after transcription intosiRNA capable of targeting, for example, BCL11A.

In one embodiment, the vector is a regulatable vector, such astetracycline inducible vector. Methods described, for example, in Wanget al. Proc. Natl. Acad. Sci. 100: 5103-5106, using pTet-On vectors (BDBiosciences Clontech, Palo Alto, Calif.) can be used. In one embodiment,the RNA interference agents used in the methods described herein aretaken up actively by cells in vivo following intravenous injection,e.g., hydrodynamic injection, without the use of a vector, illustratingefficient in vivo delivery of the RNA interfering agents. One method todeliver the siRNAs is catheterization of the blood supply vessel of thetarget organ. Other strategies for delivery of the RNA interferenceagents, e.g., the siRNAs or shRNAs used in the methods of the invention,may also be employed, such as, for example, delivery by a vector, e.g.,a plasmid or viral vector, e.g., a lentiviral vector. Such vectors canbe used as described, for example, in Xiao-Feng Qin et al. Proc. Natl.Acad. Sci. U.S.A., 100: 183-188. Other delivery methods include deliveryof the RNA interfering agents, e.g., the siRNAs or shRNAs of theinvention, using a basic peptide by conjugating or mixing the RNAinterfering agent with a basic peptide, e.g., a fragment of a TATpeptide, mixing with cationic lipids or formulating into particles. TheRNA interference agents, e.g., the siRNAs targeting BCL11A mRNA, may bedelivered singly, or in combination with other RNA interference agents,e.g., siRNAs, such as, for example siRNAs directed to other cellulargenes. BCL11A siRNAs may also be administered in combination with otherpharmaceutical agents which are used to treat or prevent diseases ordisorders associated with oxidative stress, especially respiratorydiseases, and more especially asthma. Synthetic siRNA molecules,including shRNA molecules, can be obtained using a number of techniquesknown to those of skill in the art. For example, the siRNA molecule canbe chemically synthesized or recombinantly produced using methods knownin the art, such as using appropriately protected ribonucleosidephosphoramidites and a conventional DNA/RNA synthesizer (see, e.g.,Elbashir, S. M. et al. (2001) Nature 411:494-498; Elbashir, S. M., W.Lendeckel and T. Tuschl (2001) Genes & Development 15:188-200; Harborth,J. et al. (2001) J. Cell Science 114:4557-4565; Masters, J. R. et al.(2001) Proc. Natl. Acad. Sci., USA 98:8012-8017; and Tuschl, T. et al.(1999) Genes & Development 13:3191-3197). Alternatively, severalcommercial RNA synthesis suppliers are available including, but notlimited to, Proligo (Hamburg, Germany), Dharmacon Research (Lafayette,Colo., USA), Pierce Chemical (part of Perbio Science, Rockford, Ill.,USA), Glen Research (Sterling, Va., USA), ChemGenes (Ashland, Mass.,USA), and Cruachem (Glasgow, UK). As such, siRNA molecules are notoverly difficult to synthesize and are readily provided in a qualitysuitable for RNAi. In addition, dsRNAs can be expressed as stem loopstructures encoded by plasmid vectors, retroviruses and lentiviruses(Paddison, P. J. et al. (2002) Genes Dev. 16:948-958; McManus, M. T. etal. (2002) RNA 8:842-850; Paul, C. P. et al. (2002) Nat. Biotechnol.20:505-508; Miyagishi, M. et al. (2002) Nat. Biotechnol. 20:497-500;Sui, G. et al. (2002) Proc. Natl. Acad. Sci., USA 99:5515-5520;Brummelkamp, T. et al. (2002) Cancer Cell 2:243; Lee, N. S., et al.(2002) Nat. Biotechnol. 20:500-505; Yu, J. Y., et al. (2002) Proc. Natl.Acad. Sci., USA 99:6047-6052; Zeng, Y., et al. (2002) Mol. Cell9:1327-1333; Rubinson, D. A., et al. (2003) Nat. Genet. 33:401-406;Stewart, S. A., et al. (2003) RNA 9:493-501). These vectors generallyhave a polIII promoter upstream of the dsRNA and can express sense andantisense RNA strands separately and/or as a hairpin structures. Withincells, Dicer processes the short hairpin RNA (shRNA) into effectivesiRNA. The targeted region of the siRNA molecule of the presentinvention can be selected from a given target gene sequence, e.g., aBCL11A coding sequence, beginning from about 25 to 50 nucleotides, fromabout 50 to 75 nucleotides, or from about 75 to 100 nucleotidesdownstream of the start codon. Nucleotide sequences may contain 5′ or 3′UTRs and regions nearby the start codon. One method of designing a siRNAmolecule of the present invention involves identifying the 23 nucleotidesequence motif AA(N19)TT (SEQ. ID. NO. 21) (where N can be anynucleotide) and selecting hits with at least 25%, 30%, 35%, 40%, 45%,50%, 55%, 60%, 65%, 70% or 75% G/C content. The “TT” portion of thesequence is optional. Alternatively, if no such sequence is found, thesearch may be extended using the motif NA(N21), where N can be anynucleotide. In this situation, the 3′ end of the sense siRNA may beconverted to TT to allow for the generation of a symmetric duplex withrespect to the sequence composition of the sense and antisense 3′overhangs. The antisense siRNA molecule may then be synthesized as thecomplement to nucleotide positions 1 to 21 of the 23 nucleotide sequencemotif. The use of symmetric 3′ TT overhangs may be advantageous toensure that the small interfering ribonucleoprotein particles (siRNPs)are formed with approximately equal ratios of sense and antisense targetRNA-cleaving siRNPs (Elbashir et al., (2001) supra and Elbashir et al.,2001 supra). Analysis of sequence databases, including but not limitedto the NCBI, BLAST, Derwent and GenSeq as well as commercially availableoligosynthesis companies such as OLIGOENGINE®, may also be used toselect siRNA sequences against EST libraries to ensure that only onegene is targeted.

Delivery of RNA Interfering Agents

Methods of delivering RNA interference agents, e.g., an siRNA, orvectors containing an RNA interference agent, to the target cells, e.g.,lymphocytes or other desired target cells, for uptake include injectionof a composition containing the RNA interference agent, e.g., an siRNA,or directly contacting the cell, e.g., a lymphocyte, with a compositioncomprising an RNA interference agent, e.g., an siRNA. In anotherembodiment, RNA interference agent, e.g., an siRNA may be injecteddirectly into any blood vessel, such as vein, artery, venule orarteriole, via, e.g., hydrodynamic injection or catheterization.Administration may be by a single injection or by two or moreinjections. The RNA interference agent is delivered in apharmaceutically acceptable carrier. One or more RNA interference agentmay be used simultaneously. In one preferred embodiment, only one siRNAthat targets human BCL11A is used. In one embodiment, specific cells aretargeted with RNA interference, limiting potential side effects of RNAinterference caused by non-specific targeting of RNA interference. Themethod can use, for example, a complex or a fusion molecule comprising acell targeting moiety and an RNA interference binding moiety that isused to deliver RNA interference effectively into cells. For example, anantibody-protamine fusion protein when mixed with siRNA, binds siRNA andselectively delivers the siRNA into cells expressing an antigenrecognized by the antibody, resulting in silencing of gene expressiononly in those cells that express the antigen. The siRNA or RNAinterference-inducing molecule binding moiety is a protein or a nucleicacid binding domain or fragment of a protein, and the binding moiety isfused to a portion of the targeting moiety. The location of thetargeting moiety can be either in the carboxyl-terminal oramino-terminal end of the construct or in the middle of the fusionprotein. A viral-mediated delivery mechanism can also be employed todeliver siRNAs to cells in vitro and in vivo as described in Xia, H. etal. (2002) Nat Biotechnol 20(10): 1006). Plasmid- or viral-mediateddelivery mechanisms of shRNA may also be employed to deliver shRNAs tocells in vitro and in vivo as described in Rubinson, D. A., et al.((2003) Nat. Genet. 33:401-406) and Stewart, S. A., et al. ((2003) RNA9:493-501). The RNA interference agents, e.g., the siRNAs or shRNAs, canbe introduced along with components that perform one or more of thefollowing activities: enhance uptake of the RNA interfering agents,e.g., siRNA, by the cell, e.g., lymphocytes or other cells, inhibitannealing of single strands, stabilize single strands, or otherwisefacilitate delivery to the target cell and increase inhibition of thetarget gene, e.g., BCL11A. The dose of the particular RNA interferingagent will be in an amount necessary to effect RNA interference, e.g.,post translational gene silencing (PTGS), of the particular target gene,thereby leading to inhibition of target gene expression or inhibition ofactivity or level of the protein encoded by the target gene.

In one embodiment, the hematopoietic progenitor cell is contacted exvivo or in vitro. In a specific embodiment, the cell being contacted isa cell of the erythroid lineage. In one embodiment, the compositioninhibits BCL11A expression.

“Hematopoietic progenitor cell” as the term is used herein, refers tocells of a stem cell lineage that give rise to all the blood cell typesincluding the myeloid (monocytes and macrophages, neutrophils,basophils, eosinophils, erythrocytes, megakaryocytes/platelets,dendritic cells), and the lymphoid lineages (T-cells, B-cells,NK-cells). A “cell of the erythroid lineage” indicates that the cellbeing contacted is a cell that undergoes erythropoiesis such that uponfinal differentiation it forms an erythrocyte or red blood cell (RBC).Such cells belong to one of three lineages, erythroid, lymphoid, andmyeloid, originating from bone marrow haematopoietic progenitor cells.Upon exposure to specific growth factors and other components of thehaematopoietic microenvironment, haematopoietic progenitor cells canmature through a series of intermediate differentiation cellular types,all intermediates of the erythroid lineage, into RBCs. Thus, cells ofthe “erythroid lineage”, as the term is used herein, comprisehematopoietic progenitor cells, rubriblasts, prorubricytes,erythroblasts, metarubricytes, reticulocytes, and erythrocytes.

In some embodiment, the haematopoietic progenitor cell has at least oneof the cell surface marker characteristic of haematopoietic progenitorcells: CD34+, CD59+, Thy1/CD90+, CD38^(lo)/−, and C-kit/CD117+.Preferably, the haematopoietic progenitor cells have several of thesemarker.

In some embodiment, the haematopoietic progenitor cells of the erythroidlineage have the cell surface marker characteristic of the erythroidlineage: CD71 and Ter119.

Stem cells, such as hematopoietic progenitor cells, are capable ofproliferation and giving rise to more progenitor cells having theability to generate a large number of mother cells that can in turn giverise to differentiated, or differentiable daughter cells. The daughtercells themselves can be induced to proliferate and produce progeny thatsubsequently differentiate into one or more mature cell types, whilealso retaining one or more cells with parental developmental potential.The term “stem cell” refers then, to a cell with the capacity orpotential, under particular circumstances, to differentiate to a morespecialized or differentiated phenotype, and which retains the capacity,under certain circumstances, to proliferate without substantiallydifferentiating. In one embodiment, the term progenitor or stem cellrefers to a generalized mother cell whose descendants (progeny)specialize, often in different directions, by differentiation, e.g., byacquiring completely individual characters, as occurs in progressivediversification of embryonic cells and tissues. Cellular differentiationis a complex process typically occurring through many cell divisions. Adifferentiated cell may derive from a multipotent cell which itself isderived from a multipotent cell, and so on. While each of thesemultipotent cells may be considered stem cells, the range of cell typeseach can give rise to may vary considerably. Some differentiated cellsalso have the capacity to give rise to cells of greater developmentalpotential. Such capacity may be natural or may be induced artificiallyupon treatment with various factors. In many biological instances, stemcells are also “multipotent” because they can produce progeny of morethan one distinct cell type, but this is not required for “stem-ness.”Self-renewal is the other classical part of the stem cell definition,and it is essential as used in this document. In theory, self-renewalcan occur by either of two major mechanisms. Stem cells may divideasymmetrically, with one daughter retaining the stem state and the otherdaughter expressing some distinct other specific function and phenotype.Alternatively, some of the stem cells in a population can dividesymmetrically into two stems, thus maintaining some stem cells in thepopulation as a whole, while other cells in the population give rise todifferentiated progeny only. Generally, “progenitor cells” have acellular phenotype that is more primitive (i.e., is at an earlier stepalong a developmental pathway or progression than is a fullydifferentiated cell). Often, progenitor cells also have significant orvery high proliferative potential. Progenitor cells can give rise tomultiple distinct differentiated cell types or to a singledifferentiated cell type, depending on the developmental pathway and onthe environment in which the cells develop and differentiate.

In the context of cell ontogeny, the adjective “differentiated”, or“differentiating” is a relative term. A “differentiated cell” is a cellthat has progressed further down the developmental pathway than the cellit is being compared with. Thus, stem cells can differentiate tolineage-restricted precursor cells (such as a hematopoietic progenitorcell), which in turn can differentiate into other types of precursorcells further down the pathway (such as an erythrocyte precursor), andthen to an end-stage differentiated cell, such as an erythrocyte, whichplays a characteristic role in a certain tissue type, and may or may notretain the capacity to proliferate further.

In one embodiment, the inhibitor of BCL11A expression is selected from asmall molecule and a nucleic acid. Alternatively, and preferably, theinhibitor of BCL11A expression is a BCL11A specific RNA interferenceagent, or a vector encoding said BCL11A specific RNA interference agent.In one specific embodiment, the RNA interference agent comprises one ormore of the nucleotide sequences of SEQ ID NO: 1-6.

As used herein, the term “small molecule” refers to a chemical agentincluding, but not limited to, peptides, peptidomimetics, amino acids,amino acid analogs, polynucleotides, polynucleotide analogs, aptamers,nucleotides, nucleotide analogs, organic or inorganic compounds (i.e.,including heteroorganic and organometallic compounds) having a molecularweight less than about 10,000 grams per mole, organic or inorganiccompounds having a molecular weight less than about 5,000 grams permole, organic or inorganic compounds having a molecular weight less thanabout 1,000 grams per mole, organic or inorganic compounds having amolecular weight less than about 500 grams per mole, and salts, esters,and other pharmaceutically acceptable forms of such compounds.

A “nucleic acid”, as described herein, can be RNA or DNA, and can besingle or double stranded, and can be selected, for example, from agroup including: nucleic acid encoding a protein of interest,oligonucleotides, nucleic acid analogues, for example peptide-nucleicacid (PNA), pseudo-complementary PNA (pc-PNA), locked nucleic acid (LNA)etc. Such nucleic acid sequences include, for example, but are notlimited to, nucleic acid sequence encoding proteins, for example thatact as transcriptional repressors, antisense molecules, ribozymes, smallinhibitory nucleic acid sequences, for example but are not limited toRNAi, shRNAi, siRNA, micro RNAi (mRNAi), antisense oligonucleotides etc.

As disclosed herein, it is an object of the present invention to providea method for increasing fetal hemoglobin levels in a mammal.

Accordingly, one aspect of the present invention provides a method forincreasing fetal hemoglobin levels in a mammal in need thereof, themethod comprising the step of contacting a hematopoietic progenitor cellin the mammal with an effective amount of a composition comprising aninhibitor of BCL11A, whereby fetal hemoglobin expression is increased,relative to expression prior to such contacting.

In connection with contacting a cell in a mammal with an inhibitor ofBCL11A, “increasing fetal hemoglobin levels in a mammal” indicates thatfetal hemoglobin in the mammal is at least 5% higher in populationstreated with a BCL11A inhibitor, than a comparable, control population,wherein no BCL11A inhibitor is present. It is preferred that the fetalhemoglobin expression in a BCL11A inhibitor treated mammal is at least10% higher, at least 20% higher, at least 30% higher, at least 40%higher, at least 50% higher, at least 60% higher, at least 70% higher,at least 80% higher, at least 90% higher, at least 1-fold higher, atleast 2-fold higher, at least 5-fold higher, at least 10 fold higher, atleast 100 fold higher, at least 1000-fold higher, or more than acomparable control treated mammal. The term “comparable control treatedmammal” is used herein to describe a mammal that has been treatedidentically, with the exception of the addition of the BCL11A inhibitor.

The term “mammal” is intended to encompass a singular “mammal” andplural “mammals,” and includes, but is not limited to humans; primatessuch as apes, monkeys, orangutans, and chimpanzees; canids such as dogsand wolves; felids such as cats, lions, and tigers; equids such ashorses, donkeys, and zebras; food animals such as cows, pigs, and sheep;ungulates such as deer and giraffes; rodents such as mice, rats,hamsters and guinea pigs; and bears. In some preferred embodiments, amammal is a human.

Accordingly, in one embodiment, the mammal has been diagnosed with ahemoglobinopathy. In a further embodiment, the hemoglobinopathy is aβ-hemoglobinopathy. In one preferred embodiment, the hemoglobinopathy isa sickle cell disease. As used herein, “sickle cell disease” can besickle cell anemia, sickle-hemoglobin C disease (HbSC), sicklebeta-plus-thalassaemia (HbS/β+), or sickle beta-zero-thalassaemia(HbS/β0). In another preferred embodiment, the hemoglobinopathy is aβ-thalassemia.

As used herein, the term “hemoglobinopathy” means any defect in thestructure or function of any hemoglobin of an individual, and includesdefects in the primary, secondary, tertiary or quaternary structure ofhemoglobin caused by any mutation, such as deletion mutations orsubstitution mutations in the coding regions of the β-globin gene, ormutations in, or deletions of, the promoters or enhancers of such genesthat cause a reduction in the amount of hemoglobin produced as comparedto a normal or standard condition. The term further includes anydecrease in the amount or effectiveness of hemoglobin, whether normal orabnormal, caused by external factors such as disease, chemotherapy,toxins, poisons, or the like.

The term “effective amount”, as used herein, refers to the amount thatis safe and sufficient to treat, lesson the likelihood of, or delay thedevelopment of a hemoglobinopathy. The amount can thus cure or result inamelioration of the symptoms of the hemoglobinopathy, slow the course ofhemoglobinopathy disease progression, slow or inhibit a symptom of ahemoglobinopathy, slow or inhibit the establishment of secondarysymptoms of a hemoglobinopathy or inhibit the development of a secondarysymptom of a hemoglobinopathy. The effective amount for the treatment ofthe hemoglobinopathy depends on the type of hemoglobinopathy to betreated, the severity of the symptoms, the subject being treated, theage and general condition of the subject, the mode of administration andso forth. Thus, it is not possible or prudent to specify an exact“effective amount”. However, for any given case, an appropriate“effective amount” can be determined by one of ordinary skill in the artusing only routine experimentation.

The treatment according to the present invention ameliorates one or moresymptoms associated with the disorder by increasing the amount of fetalhemoglobin in the individual. Symptoms typically associated with ahemoglobinopathy, include for example, anemia, tissue hypoxia, organdysfunction, abnormal hematocrit values, ineffective erythropoiesis,abnormal reticulocyte (erythrocyte) count, abnormal iron load, thepresence of ring sideroblasts, splenomegaly, hepatomegaly, impairedperipheral blood flow, dyspnea, increased hemolysis, jaundice, anemicpain crises, acute chest syndrome, splenic sequestration, priapism,stroke, hand-foot syndrome, and pain such as angina pectoris.

In one embodiment, the hematopoietic progenitor cell is contacted exvivo or in vitro, and the cell or its progeny is administered to saidmammal. In a further embodiment, the hematopoietic progenitor cell is acell of the erythroid lineage.

In one embodiment, the hematopoietic progenitor cell is contacted with acomposition comprising of an inhibitor of BCL11A and a pharmaceuticallyacceptable carrier or diluent. In one embodiment, said composition isadministered by injection, infusion, instillation, or ingestion.

As used herein, the term “pharmaceutically acceptable”, and grammaticalvariations thereof, as they refer to compositions, carriers, diluentsand reagents, are used interchangeably and represent that the materialsare capable of administration to or upon a mammal without the productionof undesirable physiological effects such as nausea, dizziness, gastricupset and the like. Each carrier must also be “acceptable” in the senseof being compatible with the other ingredients of the formulation. Apharmaceutically acceptable carrier will not promote the raising of animmune response to an agent with which it is admixed, unless so desired.The preparation of a pharmacological composition that contains activeingredients dissolved or dispersed therein is well understood in the artand need not be limited based on formulation. The pharmaceuticalformulation contains a compound of the invention in combination with oneor more pharmaceutically acceptable ingredients. The carrier can be inthe form of a solid, semi-solid or liquid diluent, cream or a capsule.Typically, such compositions are prepared as injectable either as liquidsolutions or suspensions, however, solid forms suitable for solution, orsuspensions, in liquid prior to use can also be prepared. Thepreparation can also be emulsified or presented as a liposomecomposition. The active ingredient can be mixed with excipients whichare pharmaceutically acceptable and compatible with the activeingredient and in amounts suitable for use in the therapeutic methodsdescribed herein. Suitable excipients are, for example, water, saline,dextrose, glycerol, ethanol or the like and combinations thereof. Inaddition, if desired, the composition can contain minor amounts ofauxiliary substances such as wetting or emulsifying agents, pH bufferingagents and the like which enhance the effectiveness of the activeingredient. The therapeutic composition of the present invention caninclude pharmaceutically acceptable salts of the components therein.Pharmaceutically acceptable salts include the acid addition salts(formed with the free amino groups of the polypeptide) that are formedwith inorganic acids such as, for example, hydrochloric or phosphoricacids, or such organic acids as acetic, tartaric, mandelic and the like.Salts formed with the free carboxyl groups can also be derived frominorganic bases such as, for example, sodium, potassium, ammonium,calcium or ferric hydroxides, and such organic bases as isopropylamine,trimethylamine, 2-ethylamino ethanol, histidine, procaine and the like.Physiologically tolerable carriers are well known in the art. Exemplaryliquid carriers are sterile aqueous solutions that contain no materialsin addition to the active ingredients and water, or contain a buffersuch as sodium phosphate at physiological pH value, physiological salineor both, such as phosphate-buffered saline. Still further, aqueouscarriers can contain more than one buffer salt, as well as salts such assodium and potassium chlorides, dextrose, polyethylene glycol and othersolutes. Liquid compositions can also contain liquid phases in additionto and to the exclusion of water. Exemplary of such additional liquidphases are glycerin, vegetable oils such as cottonseed oil, andwater-oil emulsions. The amount of an active agent used in the inventionthat will be effective in the treatment of a particular disorder orcondition will depend on the nature of the disorder or condition, andcan be determined by standard clinical techniques. The phrase“pharmaceutically acceptable carrier or diluent” means apharmaceutically acceptable material, composition or vehicle, such as aliquid or solid filler, diluent, excipient, solvent or encapsulatingmaterial, involved in carrying or transporting the subject agents fromone organ, or portion of the body, to another organ, or portion of thebody.

As used herein, “administered” refers to the placement of an inhibitorof BCL11A into a subject by a method or route which results in at leastpartial localization of the inhibitor at a desired site. An agent whichinhibits BCL11A can be administered by any appropriate route whichresults in effective treatment in the subject, i.e. administrationresults in delivery to a desired location in the subject where at leasta portion of the composition delivered, i.e. at least one agent whichinhibits BCL11A, is active in the desired site for a period of time. Theperiod of time the inhibitor is active depends on the half-life in vivoafter administration to a subject, and can be as short as a few hours,e. g. twenty-four hours, to a few days, to as long as several years.Modes of administration include injection, infusion, instillation, oringestion. “Injection” includes, without limitation, intravenous,intramuscular, intraarterial, intrathecal, intraventricular,intracapsular, intraorbital, intracardiac, intradermal, intraperitoneal,transtracheal, subcutaneous, subcuticular, intraarticular, sub capsular,subarachnoid, intraspinal, intracerebro spinal, and intrasternalinjection and infusion.

In one embodiment, the hematopoietic progenitor cell from a mammalneeding treatment is contacted with a composition that inhibits BCL11Aexpression.

By “inhibits BCL11A expression” is meant that the amount of expressionof BCL11A is at least 5% lower in populations treated with a BCL11Ainhibitor, than a comparable, control population, wherein no BCL11Ainhibitor is present. It is preferred that the percentage of BCL11Aexpression in a BCL11A inhibitor treated population is at least 10%lower, at least 20% lower, at least 30% lower, at least 40% lower, atleast 50% lower, at least 60% lower, at least 70% lower, at least 80%lower, at least 90% lower, at least 1-fold lower, at least 2-fold lower,at least 5-fold lower, at least 10 fold lower, at least 100 fold lower,at least 1000-fold lower, or more than a comparable control treatedpopulation in which no BCL11A inhibitor is added.

In one embodiment, the inhibitor of BCL11A expression is selected from asmall molecule and a nucleic acid. In a preferred embodiment, thenucleic acid is a BCL11A specific RNA interference agent or a vectorencoding said RNA interference agent, or an aptamer that binds BCL11A.In a preferred embodiment, said RNA interference agent comprises one ormore of the nucleotide sequences of SEQ ID NO:1-6.

In one embodiment, the hematopoietic progenitor cell from a mammalneeding treatment is contacted with a composition that inhibits BCL11Aactivity.

By “inhibits BCL11A activity” is meant that the amount of functionalactivity of BCL11A is at least 5% lower in populations treated with aBCL11A inhibitor, than a comparable, control population, wherein noBCL11A inhibitor is present. It is preferred that the percentage ofBCL11A activity in a BCL11A-inhibitor treated population is at least 10%lower, at least 20% lower, at least 30% lower, at least 40% lower, atleast 50% lower, at least 60% lower, at least 70% lower, at least 80%lower, at least 90% lower, at least 1-fold lower, at least 2-fold lower,at least 5-fold lower, at least 10 fold lower, at least 100 fold lower,at least 1000-fold lower, or more than a comparable control treatedpopulation in which no BCL11A inhibitor is added. At a minimum, BCL11Aactivity can be assayed by determining the amount of BCL11A expressionat the protein or mRNA levels, using techniques standard in the art.Alternatively, or in addition, BCL11A activity can be determined using areporter construct, wherein the reporter construct is sensitive toBCL11A activity. The γ-globin locus sequence is recognizable by thenucleic acid-binding motif of the BCL11A construct. Alternatively, or inaddition, BCL11A activity can be assayed by measuring fetal hemoglobinexpression at the mRNA or protein level following treatment with acandidate BCL11A inhibitor. An increase in fetal hemoglobin expressionof at least 10% is indicative of a compound being a candidate BCL11Ainhibitor.

In one embodiment, the inhibitor of BCL11A activity is selected from thegroup consisting of an antibody against BCL11A or an antigen-bindingfragment thereof, a small molecule, and a nucleic acid. In one preferredembodiment, the nucleic acid is a BCL11A specific RNA interferenceagent, a vector encoding the RNA interference agent, or an aptamer thatbinds BCL11A. In another preferred embodiment, the RNA interferenceagent comprises one or more of the nucleotide sequences of SEQ ID NO:1-6.

An “antibody” that can be used according to the methods described hereinincludes complete immunoglobulins, antigen binding fragments ofimmunoglobulins, as well as antigen binding proteins that compriseantigen binding domains of immunoglobulins. Antigen binding fragments ofimmunoglobulins include, for example, Fab, Fab′, F(ab′)₂, scFv and dAbs.Modified antibody formats have been developed which retain bindingspecificity, but have other characteristics that may be desirable,including for example, bispecificity, multivalence (more than twobinding sites), and compact size (e.g., binding domains alone). Singlechain antibodies lack some or all of the constant domains of the wholeantibodies from which they are derived. Therefore, they can overcomesome of the problems associated with the use of whole antibodies. Forexample, single-chain antibodies tend to be free of certain undesiredinteractions between heavy-chain constant regions and other biologicalmolecules. Additionally, single-chain antibodies are considerablysmaller than whole antibodies and can have greater permeability thanwhole antibodies, allowing single-chain antibodies to localize and bindto target antigen-binding sites more efficiently. Furthermore, therelatively small size of single-chain antibodies makes them less likelyto provoke an unwanted immune response in a recipient than wholeantibodies. Multiple single chain antibodies, each single chain havingone VH and one VL domain covalently linked by a first peptide linker,can be covalently linked by at least one or more peptide linker to formmultivalent single chain antibodies, which can be monospecific ormultispecific. Each chain of a multivalent single chain antibodyincludes a variable light chain fragment and a variable heavy chainfragment, and is linked by a peptide linker to at least one other chain.The peptide linker is composed of at least fifteen amino acid residues.The maximum number of linker amino acid residues is approximately onehundred. Two single chain antibodies can be combined to form a diabody,also known as a bivalent dimer. Diabodies have two chains and twobinding sites, and can be monospecific or bispecific. Each chain of thediabody includes a VH domain connected to a VL domain. The domains areconnected with linkers that are short enough to prevent pairing betweendomains on the same chain, thus driving the pairing betweencomplementary domains on different chains to recreate the twoantigen-binding sites. Three single chain antibodies can be combined toform triabodies, also known as trivalent trimers. Triabodies areconstructed with the amino acid terminus of a VL or VH domain directlyfused to the carboxyl terminus of a VL or VH domain, i.e., without anylinker sequence. The triabody has three Fv heads with the polypeptidesarranged in a cyclic, head-to-tail fashion. A possible conformation ofthe triabody is planar with the three binding sites located in a planeat an angle of 120 degrees from one another. Triabodies can bemonospecific, bispecific or trispecific. Thus, antibodies useful in themethods described herein include, but are not limited to, naturallyoccurring antibodies, bivalent fragments such as (Fab′)2, monovalentfragments such as Fab, single chain antibodies, single chain Fv (scFv),single domain antibodies, multivalent single chain antibodies,diabodies, triabodies, and the like that bind specifically with anantigen.

Antibodies can also be raised against a polypeptide or portion of apolypeptide by methods known to those skilled in the art. Antibodies arereadily raised in animals such as rabbits or mice by immunization withthe gene product, or a fragment thereof. Immunized mice are particularlyuseful for providing sources of B cells for the manufacture ofhybridomas, which in turn are cultured to produce large quantities ofmonoclonal antibodies. Antibody manufacture methods are described indetail, for example, in Harlow et al., 1988. While both polyclonal andmonoclonal antibodies can be used in the methods described herein, it ispreferred that a monoclonal antibody is used where conditions requireincreased specificity for a particular protein.

In one embodiment, the inhibitor of BCL11A activity interferes withBCL11A interactions with BCL11A binding partners. In one embodiment, thebinding partners are GATA-1, FOG-1, and components of the NuRD complex.In another embodiment, the binding partners are matrin-3, MTA2 andRBBP7.

By “interferes with BCL11A interactions with BCL11A binding partners” ismeant that the amount of interaction of BCL11A with the BCL11A bindingpartner is at least 5% lower in populations treated with a BCL11Ainhibitor, than a comparable, control population, wherein no BCL11Ainhibitor is present. It is preferred that the amount of interaction ofBCL11A with the BCL11A binding partner in a BCL11A-inhibitor treatedpopulation is at least 10% lower, at least 20% lower, at least 30%lower, at least 40% lower, at least 50% lower, at least 60% lower, atleast 70% lower, at least 80% lower, at least 90% lower, at least 1-foldlower, at least 2-fold lower, at least 5-fold lower, at least 10 foldlower, at least 100 fold lower, at least 1000-fold lower, or more than acomparable control treated population in which no BCL11A inhibitor isadded. At a minimum, BCL11A interaction can be assayed by determiningthe amount of BCL11A binding to the BCL11A binding partner usingtechniques standard in the art, including, but not limited to, massspectrometry, immunoprecipitation, or gel filtration assays.Alternatively, or in addition, BCL11A activity can be assayed bymeasuring fetal hemoglobin expression at the mRNA or protein levelfollowing treatment with a candidate BCL11A inhibitor.

In one embodiment, BCL11A activity is the interaction of BCL11A with itsbinding partners: GATA-1, FOG-1, components of the NuRD complex,matrin-3, MTA2 and RBBP7. Accordingly, any antibody or fragment thereof,small molecule, chemical or compound that can block this interaction isconsidered an inhibitor of BCL11A activity.

In one embodiment, any method known it he art can be used to measure anincrease in fetal hemoglobin expression, e. g. Western Blot analysis offetal γ-globin protein and quantifying mRNA of fetal γ-globin.

As disclosed herein, also encompassed within the objects of the presentinvention are methods for screening for modulators of BCL11A activity orexpression for the identification of inhibitors of BCL11A.

Accordingly, one aspect of the present invention provides for a methodfor identifying a modulator of BCL11A activity or expression, the methodcomprising contacting a hematopoietic progenitor cell with a compositioncomprising a test compound, and measuring the level of fetal hemoglobinor fetal hemoglobin mRNA in said cell or its progeny, wherein anincrease in fetal hemoglobin is indicative that said test compound is acandidate inhibitor of BCL11A activity or expression.

In one embodiment, the hematopoietic progenitor cell is contacted invivo, ex vivo, or in vitro. In one embodiment, the cell is of human,non-human primate, or mammalian origin. In one embodiment, the testcompound is a small molecule, antibody or nucleic acid. In oneembodiment, the composition causes an increase in fetal hemoglobinexpression.

Definitions

For convenience, certain terms employed in the entire application(including the specification, examples, and appended claims) arecollected here. Unless defined otherwise, all technical and scientificterms used herein have the same meaning as commonly understood by one ofordinary skill in the art to which this invention belongs.

As used herein, the term “vector” refers to a nucleic acid moleculecapable of transporting another nucleic acid to which it has beenlinked. One type of vector is a “plasmid”, which refers to a circulardouble stranded DNA loop into which additional nucleic acid segments canbe ligated. Another type of vector is a viral vector; wherein additionalnucleic acid segments can be ligated into the viral genome. Certainvectors are capable of autonomous replication in a host cell into whichthey are introduced (e.g., bacterial vectors having a bacterial originof replication and episomal mammalian vectors). Other vectors (e.g.,non-episomal mammalian vectors) are integrated into the genome of a hostcell upon introduction into the host cell, and thereby are replicatedalong with the host genome. Moreover, certain vectors are capable ofdirecting the expression of genes to which they are operatively linked.Such vectors are referred to herein as “recombinant expression vectors”,or more simply “expression vectors.” In general, expression vectors ofutility in recombinant DNA techniques are often in the form of plasmids.In the present specification, “plasmid” and “vector” can be usedinterchangeably as the plasmid is the most commonly used form of vector.However, the invention is intended to include such other forms ofexpression vectors, such as viral vectors (e.g., replication defectiveretroviruses, lentiviruses, adenoviruses and adeno-associated viruses),which serve equivalent functions. In one embodiment, lentiviruses areused to deliver one or more siRNA molecule of the present invention to acell.

Within an expression vector, “operably linked” is intended to mean thatthe nucleotide sequence of interest is linked to the regulatorysequence(s) in a manner which allows for expression of the nucleotidesequence (e.g., in an in vitro transcription/translation system or in atarget cell when the vector is introduced into the target cell). Theterm “regulatory sequence” is intended to include promoters, enhancersand other expression control elements (e.g., polyadenylation signals).Such regulatory sequences are described, for example, in Goeddel; GeneExpression Technology: Methods in Enzymology 185, Academic Press, SanDiego, Calif. (1990). Regulatory sequences include those which directconstitutive expression of a nucleotide sequence in many types of hostcell and those which direct expression of the nucleotide sequence onlyin certain host cells (e.g., tissue-specific regulatory sequences).Furthermore, the RNA interfering agents may be delivered by way of avector comprising a regulatory sequence to direct synthesis of thesiRNAs of the invention at specific intervals, or over a specific timeperiod. It will be appreciated by those skilled in the art that thedesign of the expression vector can depend on such factors as the choiceof the target cell, the level of expression of siRNA desired, and thelike.

The expression vectors of the invention can be introduced into targetcells to thereby produce siRNA molecules of the present invention. Inone embodiment, a DNA template, e.g., a DNA template encoding the siRNAmolecule directed against the mutant allele, may be ligated into anexpression vector under the control of RNA polymerase III (Pol III), anddelivered to a target cell. Pol III directs the synthesis of small,noncoding transcripts which 3′ ends are defined by termination within astretch of 4-5 thymidines. Accordingly, DNA templates may be used tosynthesize, in vivo, both sense and antisense strands of siRNAs whicheffect RNAi (Sui, et al. (2002) PNAS 99(8):5515).

As used in this specification and the appended claims, the singularforms “a,” “an,” and “the” include plural references unless the contextclearly dictates otherwise. Thus for example, references to “the method”includes one or more methods, and/or steps of the type described hereinand/or which will become apparent to those persons skilled in the artupon reading this disclosure and so forth. It is understood that theforegoing detailed description and the following examples areillustrative only and are not to be taken as limitations upon the scopeof the invention. Various changes and modifications to the disclosedembodiments, which will be apparent to those of skill in the art, may bemade without departing from the spirit and scope of the presentinvention. Further, all patents, patent applications, and publicationsidentified are expressly incorporated herein by reference for thepurpose of describing and disclosing, for example, the methodologiesdescribed in such publications that might be used in connection with thepresent invention. These publications are provided solely for theirdisclosure prior to the filing date of the present application. Nothingin this regard should be construed as an admission that the inventorsare not entitled to antedate such disclosure by virtue of priorinvention or for any other reason. All statements as to the date orrepresentation as to the contents of these documents are based on theinformation available to the applicants and do not constitute anyadmission as to the correctness of the dates or contents of thesedocuments.

The present invention can be defined in any of the followingalphabetized paragraphs:

-   -   [A] A method for increasing fetal hemoglobin levels in a cell,        the method comprising the steps of contacting a hematopoietic        progenitor cell with an effective amount of a composition        comprising an inhibitor of BCL11A, whereby fetal hemoglobin        expression is increased in said cell, or its progeny, relative        to the cell prior to said contacting.    -   [B] The method of paragraph [A], wherein the hematopoietic        progenitor cell is a cell of the erythroid lineage.    -   [C] The method of paragraph [A], wherein the hematopoietic        progenitor cell is contacted ex vivo or in vitro.    -   [D] The method of paragraph [A], wherein the composition        comprising an inhibitor of BCL11A inhibits BCL11A expression.    -   [E] The method of paragraph [D], wherein the inhibitor of BCL11A        expression is selected from a small molecule and a nucleic acid.    -   [F] The method of paragraph [E], wherein the nucleic acid is a        BCL11A specific RNA interference agent, or a vector encoding a        BCL11A specific RNA interference agent.    -   [G] The method of paragraph [F], wherein the RNA interference        agent comprises one or more of the nucleotide sequences of SEQ        ID NO:1-6.    -   [H] The method of paragraph [A], wherein the composition        comprising an inhibitor of BCL11A inhibits BCL11A activity.    -   [I] The method of paragraph [H], wherein the inhibitor of BCL11A        activity is selected from the group consisting of an antibody        against BCL11A or an antigen-binding fragment thereof, a small        molecule, and a nucleic acid.    -   [J] The method of paragraph [I], wherein the nucleic acid is a        BCL11A specific RNA interference agent, a vector encoding a RNA        interference agent, or an a tamer that binds BCL11A.    -   [K] The method of paragraph [J], wherein the RNA interference        agent comprises one or more of the nucleotide sequences of SEQ        ID NO:1-6.    -   [L] A method for increasing fetal hemoglobin levels in a mammal        in need thereof, the method comprising the step of contacting a        hematopoietic progenitor cell in said mammal with an effective        amount of a composition comprising an inhibitor of BCL11A,        whereby fetal hemoglobin expression is increased in said mammal,        relative to expression prior to said contacting.    -   [M] The method of paragraph [L], wherein the mammal has been        diagnosed with a hemoglobinopathy.    -   [N] The method of paragraph [M], wherein the hemoglobinopathy is        a β-hemoglobinopathy.    -   [O] The method of paragraph [M], wherein the hemoglobinopathy is        sickle cell disease.    -   [P] The method of paragraph [M], wherein the hemoglobinopathy is        β-thalassemia.    -   [Q] The method of paragraph [L], wherein the hematopoietic        progenitor cell is contacted ex vivo or in vitro, and said cell        or its progeny is administered to said mammal.    -   [R] The method of paragraph [L], wherein the contacting        comprises contacting said cell with a composition comprising of        an inhibitor of BCL11A and a pharmaceutically acceptable carrier        or diluent.    -   [S] The method of paragraph [L], wherein the composition is        administered by injection, infusion, instillation, or ingestion.    -   [T] The method of paragraph [L], wherein the composition        comprising an inhibitor of BCL11A inhibits BCL11A expression.    -   [U] The method of paragraph [T], wherein the inhibitor of BCL11A        expression is selected from a small molecule and a nucleic acid.    -   [V] The method of paragraph [U], wherein the nucleic acid is a        BCL11A specific RNA interference agent or a vector encoding a        RNA interference agent, or an a tamer that binds BCL11A.    -   [W] The method of paragraph [V], wherein the RNA interference        agent comprises one or more of the nucleotide sequences of SEQ        ID NO:1-6.    -   [X] The method of paragraph [L], wherein the composition        comprising an inhibitor of BCL11A inhibits BCL11A activity.    -   [Y] The method of paragraph [X], wherein the inhibitor of BCL11A        activity is selected from the group consisting of an antibody        against BCL11A or an antigen-binding fragment thereof, a small        molecule, and a nucleic acid.    -   [Z] The method of paragraph [Y], wherein the nucleic acid is a        BCL11A specific RNA interference agent, a vector encoding said        RNA interference agent, or an a tamer that binds BCL11A.    -   [AA] The method of paragraph [Z], wherein the RNA interference        agent comprises one or more of the nucleotide sequences of SEQ        ID NO:1-6.    -   [BB] A method for identifying a modulator of BCL11A activity or        expression, the method comprising contacting a hematopoietic        progenitor cell with a composition comprising a test compound,        and measuring the level of fetal hemoglobin or fetal hemoglobin        mRNA in said cell or its progeny, wherein an increase in fetal        hemoglobin is indicative that said test compound is a candidate        inhibitor of BCL11A activity or expression.    -   [CC] The method of paragraph [AA], wherein the hematopoietic        progenitor cell is contacted in vivo, ex vivo, or in vitro.    -   [DD] The method of paragraph [AA], wherein the cell is of human,        non-human primate, or mammalian origin.    -   [EE] The method of paragraph [AA], wherein the test compound is        a small molecule, antibody or nucleic acid.    -   [FF] The method of paragraph [AA], wherein the composition        causes an increase in fetal hemoglobin mRNA or protein        expression.

This invention is further illustrated by the following example whichshould not be construed as limiting. The contents of all referencescited throughout this application, as well as the figures and table areincorporated herein by reference.

Example 1 Materials and Methods Cell Culture

Mouse erythroleukemia (MEL) cells were cultured and subclones carryingthe BirA enzyme and tagged versions of BCL11A were created as previouslydescribed (Woo et al., Mol Cell Biol 28, 2675 (2008)). All constructswere created using standard recombinant DNA techniques. MEL cells weremaintained in Dulbecco's modified Eagle's medium (DMEM) with 10% fetalcalf serum (FCS) and 2% penicillin-streptomycin (P/S). Appropriateantibiotics were added to the medium as necessary for selection ormaintenance of clones, as described (Woo et al., Mol Cell Biol 28, 2675(2008)).

COS-7 and 293T cells were maintained in DMEM with 10% FCS. These cellswere transfected with the FuGene 6 (Roche) reagent according tomanufacturer's protocol.

Primary human CD34+ cells were obtained from magnetically-sortedmononuclear samples of G-CSF mobilized peripheral blood from donors andwere frozen down after isolation. Cells were obtained from the YaleCenter of Excellence in Molecular Hematology (YCEMH). Cells were thawedand washed into RPMI 1640 with 10% FCS, and then seeded in StemSpan SFEMMedium (StemCell Technologies Inc.) with 1×CC100 cytokine mix (StemCellTechnologies Inc.) and 2% P/S. Cells were maintained in this expansionmedium at a density of 0.1-1×10⁶ cells/ml with media changes every otheror every third day as necessary. Cells were kept in expansion medium fora total of 6 days. On day 6, cells were reseeded into StemSpan SFEMMedium with 2% P/S, 20 ng/ml SCF, 1 U/ml Epo, 5 ng/ml IL-3, 2 micromolardexamethasone, and 1 micromolar β-estradiol. Cells were maintained indifferentiation medium, with media changes every other or every thirdday as needed. Cells were maintained at a density of 0.1-1×10⁶ cells/ml.By day 3 of differentiation, homogeneous larger blasts were present inthe culture. By day 5, the majority of cells had proerythroblastmorphology and on day 7 the majority of the cells had basophilicerythroblast morphology. By day 12 of differentiation, the majority ofcells were of orthochromatophilic and polychromatophilic erythroblastmorphology.

Hemolysates were prepared from cells on day 12 of differentiation, ashas been described (Sankaran et al., Genes Dev. 22:463 (2008)), usingosmotic lysis in water and three rapid freeze-thaw cycles. Debris werecleared by centrifugation and the lysates were stored at −80° C. or fora few days at 4° C. Hemoglobin electrophoresis with cellulose acetateand high performance liquid chromatography (HPLC) were carried out inthe clinical laboratories of the Brigham and Women's Hospital usingclinically-calibrated standards for the human hemoglobins.

RNA Extraction and qRT-PCR

Isolation of RNA was performed using the Trizol reagent (Sigma) or withthe RNeasy Mini Kit (Qiagen). RNA obtained using the Trizol reagentmethod was subsequently treated with the RQ1 DNase (Promega) before cDNAsynthesis occurred. An on-column DNase (Qiagen) digestion was performedaccording to manufacturer's instructions with the RNeasy Mini Kit. cDNAwas synthesized with the iScript cDNA synthesis Kit (Bio-Rad). Real-timePCR was performed using the iQ SYBR Green Mastermix (Bio-Rad), asdescribed previously (Sankaran et al., Genes Dev. 22:463 (2008)).Relative expression was quantitated using the ΔΔCt method as describedpreviously (Sankaran et al., Genes Dev 22, 463 (2008)). Sequences ofprimers used for RT-PCR are available on request. Preparation of samplesfor expression microarray analysis was done as previously described(Sankaran et al., Genes Dev 22, 463 (2008)) and microarrays were processby the Dana-Farber Cancer Institute Microarray Core Facility. Dataprocessing was performed using dChip at the Harvard University WorldWide Web site computer lab and at the r-project organization World WideWeb site) with filtering performed as described previously (Sankaran et.al., Genes Dev 22, 463 (2008); Mootha et al., Nat Genet 34, 267 (2003);Su et al., Proc. Natl. Acad. Sci. U.S.A. 101:6062 (2004); and Su et al.,Proc. Natl. Acad. Sci. U.S.A. 99:4465 (2002)). Since prior work hadsuggested that Affymetrix average difference levels of <100 for at leastone sample represent RNAs that are unlikely to be expressed (Su et al.,Proc. Natl. Acad. Sci. U.S.A. 99:4465 (2002)), this was used as thefiltering criteria for all analyses performed here.

Proteomic Analysis

Analysis of protein interaction partners using affinity tagged versionsof BCL11A was performed as previously described (Woo et al., Mol. Cell.Biol. 28:2675 (2008)). Mass spectrometric analysis was performed at theTaplin Biological Mass Spectrometry Facility at Harvard Medical School.Following identification of peptides in individual samples (with threesamples submitted per gel lane), redundancy was collapsed. A subtractiveapproach was then employed to identify proteins that were specificallypurified in the BCL11A pulldowns and not in the control pulldowns in theparental MEL cell lines containing the BirA enzyme. Data were thenconsolidated by identifying proteins that were common in independentexperiments. All nuclear extract (NE) preparations, candidateimmunoprecipitations (IPs), gel filtration of NEs, transient exogenousexpression with IPs, and mapping studies were carried out using methodsthat have been described previously (Woo et al., Mol Cell Biol 28, 2675(2008)).

siRNA and shRNA Knockdown

Pooled siRNAs samples were obtained from Dharmacon. This included anon-targeting pool (D-001810-10) and a BCL11A targeting pool(L-006996-00). The BCL11A siRNA target sequences used are presented inTable 1.

TABLE 1 SEQ ID NO 1 GAGCACAAACGGAAACAAU SEQ ID NO 2 GCCACAGGAUGACGAUUGUSEQ ID NO 3 GCACUUAAGCAAACGGGAA SEQ ID NO 4 ACAGAACACUCAUGGAUUAThese siRNAs were prepared as 100 μM stocks, as recommended by themanufacturer. Aliquots were stored at −80° C. until use. siRNAs wereintroduced into expanded and differentiating CD34 cells using theMicroporator-Mini (Digital Bio Technology). Manufacturer's protocolswere followed and after screening a number of conditions, it was foundthat with a single pulse of 1800 V (using a pulse width of 20 ms) thebest transduction efficiency was obtained, as assessed using a GFPreporter plasmid. Transduction efficiency was estimated to be ˜50-60% ofviable cells. Typically, ˜250,000 cells were transduced with 4 μl ofsiRNAs in a volume of ˜15 μl. Cells were then seeded into freshdifferentiation medium.

shRNA clones in the pLKO vector were obtained from a large collection ofshRNAs that has been previously described (Moffat et al., Cell 124:1283(2006)). Two shRNAs targeting BCL11A were obtained with the sequencespresented Table 2:

SEQ ID NO 5 CCGGCGCACAGAACACTCATGGATTCTCGAGAATCCATGAGTGTTCTGTG CGTTTTTGSEQ ID NO 6 CCGGCCAGAGGATGACGATTGTTTACTCGAGTAAACAATCGTCATCCTCT GGTTTTTG

These shRNAs were chosen, since they target both of the major isoformsof BCL11A found in erythroid cells. Lentiviruses were prepared andinfection of cells was carried out as described (Moffat et al., Cell124:1283 (2006)). The cells were washed twice with PBS and media waschanged 24 hours after the infection. Selection with puromycin wasinitiated at 48 hours following infection, which generally correspondedto the time when the cells were seeded into differentiation medium.

Results Inverse Correlation of BCL11A and HbF Levels

As a first step in seeking how variation at the BCL11A locus mightrelate to globin expression, expression of BCL11A in erythroid cells wasexamined. In primary adult human erythroid cells, BCL11A is expressed astwo major isoforms at the protein and RNA levels (FIG. 1A). Theseisoforms have been previously designated isoforms 1 and 2 or XL and L(Liu et al., Mol Cancer 5, 18 (2006)). The XL and L isoforms differ onlyin usage of the 3′ terminal exon and appear to bind one another andfunction similarly in other settings (Liu et al., Mol. Cancer 5, 18(2006)). A western blot shows the major isoforms, XL and L, from nuclearextracts of human erythroid cells (A). These two isoforms, which couldalso be confirmed by RT-PCR of all known and predicted exons, aredepicted on the right hand side of this panel with the appropriate exonnumbers shown above the diagram. Interrogation of the expression patternof BCL11A in a collection of expression data from human cells (Su etal., Proc. Natl. Acad. Sci. U.S.A. 101:6062 (2004)) reveals an inversecorrelation between the expression of BCL11A and that of the β-globingene in cells of the erythroid lineage (FIG. 1B). The expression ofBCL11A in erythroid cells at different stages of human ontogeny and withvarying patterns of globin gene expression are shown (FIG. 1B), asassessed from a large collection of expression data in human tissues andcell types (Su et al., Proc. Natl. Acad. Sci. U.S.A. 101:6062 (2004)).The top panel shows the normalized expression (across a panel of 79human cell types, performed at least in duplicate for each cell type) ofBCL11A in the different erythroid cell types and stages listed at thebottom from probe 219497_s_at. Similar results were seen with BCL11Aprobes 219498_s_at and 210347_s_at. The bottom panel shows thenormalized levels of fetal and embryonic human globins from thisdataset. The data were normalized as for the top panel and then relativepercentages were calculated based upon all of the human β-globin genes(including the ε-, γ-, δ- and β-globin genes). Notably, BCL11Aexpression is very low in fetal liver erythroid cells and in theembryonic erythroid cell line K562. The inverse correlation indicatesthat BCL11A expression is developmentally stage-restricted. Furthermore,the temporal pattern is consistent with BCL11A acting as a potentialrepressor of γ-globin expression.

Genetic variants in intron 2 of the BCL11A gene are significantlyassociated with HbF levels in normal individuals and patients withhemoglobin disorders (Lettre et al., Proc. Natl. Acad. Sci. U.S.A.(2008); Uda et al., Proc. Natl. Acad. Sci. USA 105:1620 (2008); andMenzel et al., Nat. Genet. 39, 1197 (2007)). The association signal hasbeen recently finely mapped to a single variant that is in close linkagedisequilibrium (LD) with the SNP rs4671393 (Lettre et al., supra(2008)). Since this association has been confirmed in multipleindependent European and African diasporic populations, expression ofBCL11A as a function of the genotype at rs4671393 in lymphoblastoid celllines from the HapMap European (CEU) and African (YRI) groups wasexamined. As shown in FIG. 2A, the common variant rs4671393 isassociated with BCL11A expression in human lymphoblastoid cell linesfrom the HapMap European (CEU) and African (YRI) populations. qRT-PCRwas performed on RNA from these cell lines and normalized to the levelof human β-actin. Two separate PCR reactions were performed that couldindividually assess levels of the XL (Top) and L (Bottom) isoforms basedon differences at the 3′ end of these genes. Similar results wereobtained by analyzing common 5′ sequences using qRT PCR. Results aredepicted as the mean with the standard error shown by error bars.Differences between genotypes were calculated using the Student t-test.The pattern of increase in HbF levels for each of these genotypes isshown at the top (Lettre et al., Proc Natl Acad Sci USA (2008)).

A striking difference was observed in expression for both the XL and Lisoforms between individuals homozygous for the low HbF allele (GG),heterozygous for both alleles, or homozygous for the minor alleleassociated with high HbF levels (AA) (FIG. 2A). Cells homozygous for the“high HbF” alleles expressed a lower level of BCL11A transcripts thanthose homozygous for “low HbF” alleles or heterozygous for both alleles.Thus, expression of BCL11A at the different human variants is inverselycorrelated with the associated HbF levels. The difference in expressionbetween the “high” and “low” HbF associated BCL11A alleles is roughly3-fold. Hence, relatively modest differences in BCL11A expression appearto associate with changes in HbF expression. Taken together with thedevelopmental pattern of expression of BCL11A, these results provideindependent, yet indirect, support for a model in which BCL11A might actas a repressor of γ-globin expression.

Surprisingly, the embryonic erythroleukemia cell line K562 was observedto express very little, if any, of the XL and L isoforms, but insteadexpressed shorter variant proteins (FIG. 2B). To assess whether thedifference between adult erythroblasts and K562 cells reflecteddevelopmental stage-specific control of BCL11A or the malignant natureof these cells, stage-matched, CD71+/CD235+ erythroblasts isolated fromadult bone marrow were examined, second trimester fetal liver (FL), andcirculating first-trimester primitive cells. FL and primitiveerythroblasts, which both robustly express γ-globin (C. Peschle et al.,1985, Nature 313, 235), expressed predominantly shorter BCL11A variants(FIG. 2B) While we are currently investigating the structure of thesevariant proteins, the findings herein indicate that the BCL11A locus isdevelopmentally regulated, such that full-length XL and L isoforms areexpressed almost exclusively in adult stage erythroblasts.Independently, the genetic data strongly argue that the level of XL andL isoforms is influenced by sequence variants in the BCL11A gene.

BCL11A Binds the NuRD Repressor Complex, GATA-1, and FOG-1 in ErythroidCells

To better understand the mechanism of action of BCL11A in erythroidcells, the proteins with which BCL11A interacts were characterized.First, affinity tagged versions of BCL11A in mouse erythroleukemia (MEL)cells were prepared (FIG. 3A). These cells represent a convenient modelof adult-type erythroid cells that express exclusively adult globins(Papayannopoulou et. al., Cell 46:469 (1986)). The scheme used for theaffinity purification in mouse erythroleukemia (MEL) cells is depictedin this diagram. Once FLAG peptide elution was performed, whole-lanemass spectrometry from acrylamide gels was done as described above. Toidentify specific interactions, a subtractive approach involving asimultaneous pulldown in parental Mel-BirA (MB) cells was used. Theresults of this subtractive screen are shown (FIG. 3B) with the numberof peptides obtained in each trial listed adjacent to the identifiedprotein. The various components of the NuRD complex are shown in blue inthis table. (FIG. 3D)

No major global transcriptional changes by microarray analysis wereobserved upon expression of tagged versions of BCL11A in these cells(FIG. 3C). The log 2 normalized intensity of filtered probes fromAffymetrix 430 2.0 arrays on the parental MB cells and a collection offour clones containing FLAG-Biotag versions of BCL11A (FBB clones) areshown in red. A linear regression is shown as a black line (r²=0.9753).The microarray analysis and filtering were performed as describedherein. The overall correlation coefficient (r²) was 0.9753 for the log2 normalized intensity of probes from the parental cell line compared toa collection of tagged BCL11A-expressing clones, indicating a closesimilarity in the transcriptional activity of these cells (with r²values of 0.9678, 0.9445, 0.9667, and 0.9736 for individual clonesshowing, respectively, 1, 1, 4, and 9-fold expression of tagged BCL11Acompared with endogenous levels). Following affinity purification ofprotein complexes containing tagged BCL11A and mass spectrometricpeptide sequencing, we identified numerous peptides of BCL11A,consistent with the observation that BCL11A can self-associate and thesecomplexes appear to involve multiple isoforms (Liu et al., Mol Cancer 5,18 (2006)) (FIG. 3B). All components of the nucleosome remodeling andhistone deacetylase (NuRD) repressive complex were retrieved, suggestinga physical association between BCL11A and the complex in erythroid cells(FIG. 3B, blue), consistent with prior observations of BCL11A in B-cellsand the homologue BCL11B in T-cells (Cismasiu et al., Oncogene 24:6753(2005)). Compatible with this observed interaction, BCL11A contains anN-terminal motif that is believed in other proteins to recruit the NuRDcomplex (FIG. 3D) (Lauberth et. al., J. Biol. Chem. 281:23922 (2006) andHong et al., Embo J. 24:2367 (2005)).

It was also found that the nuclear matrix protein, matrin-3 (Nakayasuet. al., Proc. Natl. Acad. Sci. U.S.A. 88:10312 (1991)), consistentlyco-purified with BCL11A, which may be responsible in part for thelocalization of BCL11A to the nuclear matrix (Liu et al., Mol. Cancer 5,18 (2006)) (FIG. 3B). Prior work has shown that the 3 globin locus isclosely associated with the nuclear matrix until later stages oferythropoeisis when high level globin gene transcription occurs (Ragoczyet. al., Genes Dev. 20:1447 (2006)). Additionally, BCL11A complexescontain peptides derived from GATA-1, the principal erythroidtranscription factor (Martin, Nature 338:435 (1989)) (FIG. 3B).

This interaction was further characterized and validated. Byimmunoprecipitation (IP), it was confirmed that GATA-1 specificallyassociates with BCL11A in erythroid cells (FIG. 4A).Immunoprecipitations (IPs) were performed with M2-agarose beads.Moreover, it was found that the GATA-1 cofactor FOG-1 (Tsang et al.,Cell 90:109 (1997)) also specifically associates with BCL11A and theinteraction with NuRD components in erythroid cells was additionallyconfirmed (FIG. 4A). Prior work has shown that FOG-1 also binds to theNuRD complex (Hong et al., Embo J. 24:2367 (2005)) and these resultssuggest that BCL11A may synergize with this interaction in the contextof specific loci.

Gel filtration fractions (every 4th fraction of 1 ml fractions is shownon the blot) from erythroid nuclear extracts are shown and blotted forBCL11A, MTA2, GATA-1, and FOG-1. On size fractionation of erythroidnuclear extracts, considerable overlap between NuRD components andBCL11A in large megadalton complexes was observed (FIG. 4B). Overlap ofBCL11A with GATA-1 and FOG-1 polypeptides was less extensive (FIG. 4B).There is significant overlap between BCL11A and MTA2, with a small peakof GATA-1 and FOG-1 seen here as well. BCL11A interactions with GATA-1(FIG. 4C) and FOG-1 (FIG. 4D) could be confirmed by exogenous expressionin Cos7 cells using FLAG-tagged versions of GATA-1 or FOG-1 and V5tagged versions of BCL11A. Using this same strategy, fragments of GATA-1(all of which show robust expression here) could be used to map theinteraction with BCL11A (FIG. 4E). Without wishing to be bound by atheory, it is possible that only a minor fraction of these factors arebound within the BCL11A and the NuRD complexes. Alternatively, in vivoassociation might be greater but dissociation of the components ofprotein complexes occurs during extract preparation and sizefractionation. GATA-1 and FOG-1 immunoprecipitated with BCL11A uponexogenous expression in non-erythroid cells, which suggests that theseproteins directly interact (FIGS. 4C and 4D). This approach was used tomap the determinants mediating association of GATA-1 with BCL11A (FIG.4E). It was found that BCL11A interacts with the zinc-fingers of GATA-1(amino acids 200-338) and this interaction appears to be partiallyinhibited by the N-terminal region of GATA-1. The N-terminal region ofGATA-1 is known to be important for normal erythropoiesis in humans(Hollanda et al., Nat. Genet. 38:807 (2006)) and is somatically mutatedin an infantile myeloproliferative disorder and leukemia arising inpatients with Down syndrome (Wechsler et al., Nat. Genet. 32:148 (2002);and Vyas et. al., Curr Opin Pediatr 19:9 (2007)). Together, theproteomic data indicate that BCL11A binds the NuRD complex along withGATA-1 and FOG-1 in erythroid cells. These associated factors are likelyto be critical for the action of BCL11A as a transcriptional repressorin erythroid cells.

Functional Assessment of BCL11A as a Repressor of HbF Expression

The results presented thus far provide genetic, developmental, andbiochemical evidence in support of a potential role for BCL11A asrepressor of γ-globin gene expression. To test this hypothesis,modulation of the level of BCL11A in primary human erythroid cells wasattempted. As a cellular system in which to perform experiments,erythroid precursors from purified CD34+ human hematopoietic progenitorswere expanded and differentiated. The effect of transient introductionof siRNAs that target BCL11A mRNA was examined. When siRNAs wereintroduced into erythroid progenitors at day 0 of differentiation,40-45% knockdown of BCL11A mRNA levels was achieved, as assessed on day4 of differentiation. With this knockdown, a ˜2.3-fold increase in thelevel of γ-globin by qRT-PCR at the basophilic erythroblast stage on day7 of differentiation was observed (FIG. 5A). With this knockdown, a2.3-fold increase in the level of γ-globin RNA was observed (from anaverage of 7 to 15.7%) at the basophilic erythroblast stage on day 7 ofdifferentiation (FIG. 5A). It was found that as these siRNAs wereintroduced at later time points during erythroid differentiation, lowerinduction of the γ-globin gene was observed (with 1.7 and 1.4-foldaverage γ-globin induction seen by adding siRNAs on days 1 and 2 ofdifferentiation).

The results observed from siRNA knockdown of BCL11A could be due to abroad effect on the cellular differentiation state, which has been shownto alter γ-globin expression (Nathan et. al., Nathan and Oski'shematology of infancy and childhood. 6th, pp. 2 v. (x9) (2003) andStamatoyannopoulos, Exp. Hematol. 33:259 (2005)), or reflect more directaction at a limited number of targets, including the γ-globin gene. Todistinguish these possibilities, microarray expression profiling of thecells following knockdown of BCL11A and subsequent differentiation wasperformed. Microarray profiling of these cells using the Affymetrix U133Plus 2.0 array reveals that there is close similarity in the expressionprofile of non-targeting and BCL11A siRNA treated cells (r²=0.9901). Theplot is shown with log 2 normalized probe intensities. Thetranscriptional profiles of genes in the quantitative range of the array(which excluded the globins) were remarkably similar between cells onday 7 after treatment with BCL11A siRNAs and non-targeting (NT) siRNAson day 0, with an r² of 0.9901 for the log 2 normalized intensities(FIG. 5B). Additionally, the morphology of these two groups of cells wasindistinguishable throughout differentiation. Together, these resultssuggest that knockdown of BCL11A is able to alter globin expressionwithout causing global changes in the differentiation state of thecells.

To examine the effects of more persistent reduction in BCL11Aexpression, lentiviral shRNA mediated knockdown of BCL11A expressionwith selection of transduced cells was utilized (Moffat et al., Cell124, 1283 (2006)). Two independent shRNA constructs were chosen for thispurpose. When cells were infected with the two BCL11A shRNA lentivirusesand drug selection was imposed upon the initiation of differentiation,an average of 97 and 60 percent knockdown BCL11A at the protein level byday 5 of erythroid differentiation was observed, based upon densitometryof western blots (FIG. 5C). At day 6 of differentiation (proerythroblastto basophilic erythroblast stage), the cells appear to beindistinguishable, as occurs morphologically at other stages ofdifferentiation as well. No morphological differences between the groupsof cells could be noted during the course of differentiation, suggestingthat as in the case of the siRNA experiments, BCL11A knockdown was notperturbing overall erythroid differentiation (FIG. 5D).

The level of γ-globin at day 7 of differentiation was dramaticallyelevated by 6.5 and 3.5-fold (from an average of 7.4 to 46.8 and 26%) inthe two sets of shRNA-mediated knockdown of BCL11A treated cellscompared with the control infected cells (FIG. 5E). This robust effectis likely to be the result of both the selection for transduced cells,as well as the continuous expression of the shRNAs following viraltransduction. Induction of γ-globin RNA was accompanied by correspondinglevels of mature HbF, as shown by hemoglobin electrophoresis and highperformance liquid chromatography (HPLC) (FIG. 5F). Hemolysates preparedfrom cells on day 12 of differentiation show the presence of mature HbF.This could be assessed using cellulose acetate hemoglobinelectrophoresis, with the smear of HbF shown in the top panels and theaverage corresponding measurement from densitometry shown below thesepanels. This could also be more accurately quantified by hemoglobinHPLC, as shown at the bottom. The HbF peaks are labeled with an arrow ineach chromatogram, with the first peak corresponding to acetylated HbFand the second unmodified HbF. The HPLC revealed that a substantialfraction of the mature hemoglobin in these cells was HbF (with anaverage level of 35.9 and 23.6%, compared with undetectable levels inthe control). Based on the variation in the extent of knockdown ofBCL11A from the siRNA and shRNA experiments and the concomitant degreeof γ-globin induction seen, it appears that BCL11A may function as amolecular rheostat to regulate the silencing of the γ-globin gene.

The molecular studies of globin switching during ontogeny have served asa paradigm for the developmental control of mammalian genes. Despiteextensive study, the exact molecular mechanisms underlying this processremain to be uncovered. Without wishing to be bound by theory, theresults described herein suggest that BCL11A is itself adevelopmentally-regulated and critical modulator of this process. Wehave shown that BCL11A represses γ-globin gene expression in primaryadult human erythroid cells. Our protein data suggest that BCL11Afunctions in concert with the NuRD repressor complex, GATA-1, and FOG-1.Of note, inhibitors of histone deacetylases (HDACs) appear to inducesome HbF in patients with hemoglobin disorders (Perrine, Hematology Am.Soc. Hematol. Educ. Program, 38 (2005)). HDAC1 and HDAC2 are both corecomponents of the NuRD complex and this association with BCL11A suggeststhat this complex may be the molecular target of these therapies. It isevident from the work on human genetics that modulation of BCL11A canelevate HbF levels and ameliorate the severity of these diseases (Lettreet al., Proc. Natl. Acad. Sci. U.S.A. (2008); Uda et al., Proc Natl AcadSci USA 105, 1620 (2008) and Menzel et al., Nat Genet 39, 1197 (2007)).As a stage-specific component involved in repression of γ-globinexpression, BCL11A emerges as a new therapeutic target for reactivationof HbF in sickle cell disease and the β-thalassemias. It is likely thatthe further study of BCL11A and its associated factors in globin generegulation will lead to an improved mechanistic understanding of thefetal switch and targeted manipulation of HbF in humans.

Example 2 Materials and Methods Experimental Animals

All experiments performed with the β-locus, K-RasG12D, BCL1 1A−/−,GATA1-Cre, and Mx1-Cre mice were approved by the Children's HospitalBoston animal ethics committee and the ethics committee of the FredHutchinson Cancer Research Center.

The wild-type β-globin locus YAC transgenic (β-YAC) mouse strains thatwere used in this study display a similar pattern of human globin geneexpression and are representative of the various strains of transgenicmice harboring the entire human β-globin locus (Peterson, K. R. et al.1993, Proc. Natl. Acad. Sci. U.S.A. 90:7593-7; Peterson, K. R., et al.1998, Hum. Mol. Genet. 7:2079-88; Harju, S., et al., 2005, Mol. CellBiol. 25:8765-78; Porcu, S. et al. 1997, Blood 90:4602-9; Gaensler, K.M., et al., 1993, Proc. Natl. Acad. Sci. U.S.A. 90:11381-5; Strouboulis,J., et al., 1992, Genes Dev. 6:1857-64). One transgenic mouse line waskindly provided by K. Peterson and was created with the insertion of a213 kb YAC containing the entire intact human β-globin locus and hasbeen described and characterized previously (Peterson, K. R. et al.1993; Peterson, K. R., et al. 1998; Harju, S., et al., 2005, supra).This β-YAC line contains three intact copies of the human β-globin locusintegrated at a single genomic locus. Two β-YAC lines (A20 and A85)harboring a single copy of an ˜150 kb β-globin locus YAC were also usedin this study and have been described previously (Porcu, S. et al. 1997,supra) (kindly provided by K. Gaensler). These transgenes weremaintained in the hemizygous state. The animals were maintained on apure C57Bl/6 background for all experiments involving adulthematopoietic analysis. A juvenile myelomonocytic leukemia-typemyeloproliferative disorder was induced by crossing the Mx1-Cre linewith the K-rasG12D conditional allele (Chan, I. T. et al., J. 2004,Clin. Invest. 113:528-38; Braun, B. S. et al., 2004, Proc. Natl. Acad.Sci. U.S.A. 101:597-602), along with the β-YAC transgene from K.Peterson. Congenic B6.SJL-PtprcaPep3b/BoyJ (Ptprca or CD45.1) mice werepurchased from Taconic Farms or The Jackson Laboratory. Mice containinga BCL11A floxed allele (with loxP sites flanking exon 1) were createdthrough gene targeting approaches and will be described in future work(G.C.I., S.D.M, and P.W.T., unpublished). To obtain the BCL11A nullallele, these mice were crossed with GATA1-Cre mice and screened forgermline deletion (Garrick, D. et al. 2006, PLoS Genet. 2:e58; Jasinski,M., et al., 2001, Blood 98:2248-55).

Adult Hematopoietic Analysis

Analyses of adult hematology, bone marrow transplants, and5-fluorouracil (5-FU) induction were performed as described previously(Sankaran, V. G., et al., 2008, Genes Dev. 22:463-475; Walkley, C. R.,et al., 2005, Nat. Cell Biol. 7:172-8). Whole PB was analyzed on aBeckman Coulter AcT (Jasinski, M., et al., 2001, supra) hematologicalanalyzer. Recipient (CD45.1) mice were irradiated with a total of 10.5Gyγ-radiation (5Gy and 5.5Gy, 3 hours apart) on the day oftransplantation. Whole BM was isolated and pooled from β-YAC mice. Atotal of 2×10⁶ cells/mouse were retro-orbitally injected intorecipients. RNA was obtained from blood using the QiaAmp Blood Mini Kit(Qiagen Inc., Valencia, Calif.) and quantitative RT-PCR (qRT-PCR) wasperformed as described (Sankaran, V. G., et al., 2008, supra; Sankaran,V. G. et al., 2008, Science 322:1839-42) (using the human globin geneprimers listed below or previously reported murine primers (Kingsley, P.D. et al., 2006, Blood 107:1665-72). The human globin gene primers wereε-globin exon 1 forward 5′-GAGAGGCAGCAGCACATATC-3′ (SEQ. ID. NO. 7),ε-globin exon 2 reverse 5′-CAGGGGTAAACAACGAGGAG-3′ (SEQ. ID. NO. 8),γ-globin exon 2 forward 5′-TGGATGATCTCAAGGGCAC-3′ (SEQ. ID. NO. 9),γ-globin exon 3 reverse 5′-TCAGTGGTATCTGGAGGACA-3′ (SEQ. ID. NO. 10),β-globin exon 1 forward 5′-CTGAGGAGAAGTCTGCCGTTA-3′ (SEQ. ID. NO. 11),and β-globin exon 2 reverse 5′-AGCATCAGGAGTGGACAGAT-3′ (SEQ. ID. NO.12). The mouse globin gene primers used were εγ globin exon 1 forward5′-TGGCCTGTGGAGTAAGGTCAA-3′ (SEQ. ID. NO. 13), εγ globin exon 2 reverse5′-GAAGCAGAGGACAAGTTCCCA-3′ (SEQ. ID. NO. 14), βh1 globin exon 2 forward5′-TGGACAACCTCAAGGAGACC-3′ (SEQ. ID. NO. 15), βh1 globin exon 3reverse5′-ACCTCTGGGGTGAATTCCTT-3′ (SEQ. ID. NO. 16), βmajor/β minorglobins exon 2 forward 5′-TTTAACGATGGCCTGAATCACTT-3′ (SEQ. ID. NO. 17),and β-major/β-minor globins exon 3 reverse 5′-CAGCACAATCACGATCATATTGC-3′(SEQ. ID. NO. 18). The mouse BCL11A qRT-PCR primers were forward5′-AACCCCAGCACTTAAGCAAA-3′(SEQ. ID. NO. 19) and reverse5′-ACAGGTGAGAAGGTCGTGGT-3′ (SEQ. ID. NO. 20).

Developmental Hematopoietic Analysis

Embryos were obtained from timed matings, bled, and Ter119 positivecells were sorted based upon forward and side scatter similar to whathas been previously described (Kingsley, P. D. et al., 2006, supra).Cells were maintained in phosphate buffered saline (PBS) with 5% fetalcalf serum (FCS). Unfractionated heparin in PBS was added to thissolution to a final concentration of 12.5 μg/ml. Immunohistochemistryusing an anti-HbF polyclonal antibody was performed on fixedparaffin-embedded sections as described (Choi, J. W., et al., 2001, Int.J. Hematol. 74:277-80). The fetal livers of E13.5 murine embryos weredissected and a single cell suspension was created. Similarly, bonemarrow cells were harvested as has been described previously from mice(Sankaran, V. G., et al., 2008, Genes Dev. 22:463-475). In both cases,the cells were labeled with Ter-1 19 and CD71, as well as 7-AAD. TheTer-119+/CD71+ populations were sorted as described previously(Sankaran, V. G., et al., 2008, supra). Stage-matched human samples wereobtained and sorted as previously described (Sankaran, V. G. et al.,2008, Science 322:1839-42). These human samples were kindly provided byH. Mikkola and B. Van Handel.

Western Blot Analysis of BCL11A

Expression of BCL11A was performed using antibody 14B5 (Abcam Inc.,ab19487), as described previously (Sankaran, V. G. et al., 2008, Science322:1839-42). Expression of GAPDH was assessed as a standard usingrabbit polyclonal antibody FL-335 (Santa Cruz Biotechnology Inc.,sc-25778).

RNA Primary Transcript FISH

Primary transcript RNA FISH was largely performed as previouslydescribed (Wijgerde, M., et al., 1995, Nature 377:209-13; Ragoczy, T.,et. al., 2006, Genes Dev. 20, 1447-57) with some modifications. Prior tohybridization, the slides were equilibrated in 50% formamide/2× SSC, pH7.0. Single-stranded DNA probes against the introns of the murine α- andεγ- and human γ- and β-globin genes were generated by in vitrotranscription of cloned intron fragments followed by reversetranscription and inclusion of DIG-11-dUTP, biotin-16-dUTP (Roche) orDNP-11-dUTP (Perkin Elmer) in the reactions as described (Bolland, D. J.et al. 2004, Nat. Immunol. 5:630-7). Labeled probes were hybridized tothe cells in 50% formamide/10% dextran sulfate/2×SSC/5 mM ribonucleotidevanadate complex/0.05% BSA/0.1 mg/ml Cot-1 DNA/1 g/μl E. coli tRNA. Theprobes were heat denatured at 80° C. for 5 minutes, preannealed at 37°C., and then hybridized overnight at 37° C. in a humid chamber. Slideswere washed in 50% formamide/2×SSC, pH 7 at 37° C., rinsed in 2×SSC andblocked in 145 mM NaCl/0.1M Tris pH 7.5/2% BSA/2 mM ribonucleotidevanadate complex. Primary transcript foci were detected by indirectimmunofluorescence with Cy3-, Alexa Fluor 488- and 647-conjugatedantibodies including one or two layers of signal amplification, asdescribed (Trimborn, T., et al., 1999, Genes Dev. 13, 112-24).

FISH Image Acquisition and Analysis

Image stacks (Z sections spaced 0.25 m apart) were captured on anOlympus IX71 microscope (Olympus objective 100×/1.40, UPLS Apo) equippedwith a cooled CCD camera using Deltavision SoftWorx software (AppliedPrecision). The presence of the globin gene primary transcripts wasdetermined in 2D projections of the Z stacks using Photoshop (Adobe).About 100-200 nuclei were analyzed for each probe set and maturationstage.

Chromatin Immunoprecipitation (ChIP) of Primary Erythroid Cells

Human CD34-derived erythroid progenitors were harvested on day 5 ofdifferentiation (proerythroblast stage). The cells were fixed using a 1%final concentration of formaldehyde and cross-linking was allowed toproceed for 10 minutes. Glycine to a final concentration of 125 mM wasthen introduced to stop the cross-linking. Cells were washed twice inPBS and cell pellets were stored at −80° C. Typically ˜15-20×10⁶ cellswere used per ChIP reaction. The ChIP assays were performed in a similarmanner to what has previously been described in J. Kim, et al., 2008,Cell 132:1049. The sonication buffer was modified with the use of 0.5%SDS, instead of 0.1%. The sonication procedure was modified with the useof 4 to 6 pulses of 30 seconds, each involving constant sonication. Thisexact procedure typically produces fragments in the range of 300-1000base pairs with this procedure. The following antibodies were used forthe ChIP procedure: BCL11A [14B5] (Abcam, ab19487), BCL11A [15E3AC11](Abcam, ab18688), BCL11A (Novus Biologicals, Inc. NB600-261), and RabbitIgG (Upstate, 12-370). Similar results were obtained with all BCL11Aantibodies in all the regions tested.

The ChIP samples were analyzed by real-time quantitative PCR (BioRad).All primers were tested for PCR efficiency as recommended by themanufacturer (BioRad). A standard curve was prepared for each set ofprimers using serial titration of the input DNA. The relative amount ofprecipitated chromatin (percent of input) was calculated fromprimer-specific standard curves using the iCycler Data AnalysisSoftware. The specific primers were designed to amplify sequences at theHS3; HBG1 promoter region; HBG1 downstream region (+3 kb); HBD upstreamregion (−1 kb); and HBB promoter region of the human β-globin locus.Additionally, a degenerate primer set that bound to the promoters ofboth HBG2 and HBG1 was used and showed similar results to the HBG1promoter primer set (with no enrichment detected).

Results

The contribution of changes in cis-regulatory elements or trans-actingfactors to interspecies differences in gene expression is not wellunderstood. The mammalian β-globin loci have served as a paradigm forgene regulation during development. Transgenic mice harboring the humanβ-globin locus, consisting of the linked embryonic (ε), fetal (γ) andadult (β) genes, have been used as a model system to study the temporalswitch from fetal to adult hemoglobin, as occurs in humans. Theinventors show that the human γ-globin genes in these mice behave asmurine embryonic globin genes, revealing a limitation of the model anddemonstrating that critical differences in the trans-acting milieu havearisen during mammalian evolution. The inventors show that theexpression of BCL11A, a repressor of human γ-globin expressionidentified through genome-wide association studies, differs betweenmouse and human. Developmental silencing of the mouse embryonic globinand human γ-globin genes fails to occur in mice in the absence ofBCL11A. Thus, BCL11A is a critical mediator of species-divergent globinswitching. By comparing the ontogeny of β-globin gene regulation in miceand humans, the inventors have shown that alterations in expression of atrans-acting factor constitute a critical driver of gene expressionchanges during evolution.

The extent to which changes in cis-regulatory elements or thetrans-acting environment account for differences in gene expression inclosely related species is the subject of debate (Carroll, S. B., 2008,Cell 134:25-36; Hoekstra, H. E. and Coyne, J. A., 2007, Evolution61:995-1016). Some studies suggest that changes in cis-regulatoryelements are largely responsible for many interspecies differences ingene expression (Wallace, H. A. et al., 2007, Cell 128:197-209; Wilson,M. D. et al., 2008, Science 322:434-8). The contribution of alterationsin the trans-acting milieu is less established. With their temporalswitches of globin expression, mammalian β-globin loci serve as aparadigm for developmental gene regulation (McGrath, K. & Palis, J.,2008, Curr. Top. Dev. Biol. 82:1-22). To study the regulation of humancis-elements in a mouse trans-acting environment, the inventors employedhuman β-globin locus transgenic mice (β-locus mice). The regulation ofthe human β-globin locus has been widely studied using such mouse models(Wijgerde, M., et al., 1995, Nature 377:209-13; Peterson, K. R., et al.,1998, Hum. Mol. Genet. 7:2079-88; Porcu, S. et al., 1997, Blood90:4602-9). It is generally accepted that these mice provide a validsystem for evaluating human developmental globin gene regulation, thoughsome differences have been noted between humans and these mice. Forexample, the onset of γ-globin expression occurs during the embryonic,yolk sac stage of erythropoiesis in the mouse, while high-levelexpression of this gene occurs during the fetal liver stage in man.Moreover, the switch from γ-globin to adult β-globin occurs during earlyfetal liver erythropoiesis in these mice (Wijgerde, M., et al., 1995;Peterson, K. R., et al., 1998, Porcu, S. et al., 1997, supra), whereasit occurs around the time of birth in humans (Peschle, C. et al., 1985,Nature 313, 235-8). In addition, differences have been noted in thecapacity of these mice to respond to fetal hemoglobin (HbF) elicitingresponses that are active in humans (Sloane-Stanley, J., 2006, Br. J.Haematol. 135:735-7; Pace, B., et al., 1994, Blood 84:4344-53). Theinventors began by evaluating whether these mice respond to stimuli thatconsistently increase the level of HbF in humans (Papayannopoulou, T.,et al., 1984, Science 224:617-9). The inventors found that these micehave much lower basal levels of γ-globin expression than adult humansand fail to respond to stimuli that result in elevated levels of HbF inhumans (FIG. 10). The graph shows, respectively, the baselinemeasurement in adult mice (n=10), bone marrow transplants with 2X106donor (β-locus mice) marrow cells (Alter, B. P., et al., 1976, Blood48:843-53) (n=10) at days 10 and 17 post-transplant, 5-FU treatment whencytopenias are at their nadir on day 7 (n=10), and a juvenilemyelomonocytic leukemia (JMML)-type of myeloproliferative disorder fromactivation of K-ras (Braun, B. S. et al. 2004, Proc. Natl. Acad. Sci.U.S.A. 101:597-602; Chan, I. T. et al. 2004, J. Clin. Invest0.113:528-38) (n=3). Data is plotted as percentage of γ-globin overtotal human β-like globin gene levels calculated based upon qRT-PCRresults. Results are shown as the mean±standard deviation of the mean.Of note, the baseline level of γ-globin is 50 to 100-fold lower than inhuman adults (Oneal, P. A. et al. 2006, Blood 108:2081-6; Nathan, D. G.,et al., 2003, in Hematology of infancy and childhood, 2 v. (xiv, 1864,xli p.) (Saunders, Philadelphia, Pa.,). Also, in a model of juvenilemyelomonocytic leukemia created in these mice, no elevation in γ-globinlevels was observed, in contrast to the high levels of γ-globin seen inhumans with this syndrome (Weatherall, D. J. et al., 1975, Nature257:710-2).

Human Fetal γ-Globin Genes Behave as Embryonic Genes in the Mouse

To pursue the underlying basis of these species differences, theinventors reassessed the ontogeny of human γ-globin expression duringmouse development. The inventors first isolated circulating blood fromembryos at a time when γ-globin expression is observed (E13.5)(Wijgerde, M., et al., 1995, Nature 377:209-13; Peterson, K. R., et al.,1998, Hum. Mol. Genet. 7:2079-88; Porcu, S. et al., 1997, Blood90:4602-9). Using differences in cell size that permit separation ofcirculating primitive and definitive lineage cells using flow cytometry(Kingsley, P. D. et al., 2006, Blood, 107:1665-72; Fraser, S. T., etal., 2007, Blood, 109:343-52), the inventors enriched the erythroidcells in blood from embryonic day 13.5 (E1 3.5) β-locus mice (FIG. 6A).As anticipated, expression of the mouse embryonic gene εγ globin, a geneconfined to the primitive erythroid lineage along with mouse βh1 globin(Kingsley, P. D. et al., 2006, Blood, 107:1665-72; Fraser, S. T., etal., 2007, Blood, 109:343-52), was enriched (approximately 5-fold) inthe primitive population relative to the definitive population (FIG.6B). Consistent with this distribution, human embryonic ε-gobintranscripts were similarly enriched in the primitive population (FIG.6B). Surprisingly, there was no difference observed between the relativeenrichment of the embryonic genes and the degree of enrichment of humanγ-globin transcripts in the primitive erythroid population compared tothe definitive cells (FIG. 6B). This finding indicates that the humanγ-gobin genes are not robustly expressed in early definitive erythroidcells in β-locus mice.

The inventors then used immunohistochemistry (IHC) of γ-globin in E13.5embryos to examine its cellular distribution. IHC of human fetal liver(FL) revealed positive labeling of all erythroblasts (FIG. 6C). Incontrast, the majority of erythroblasts present in the murine FL ofβ-locus mice failed to stain for γ-globin. The inventors observedoccasional large nucleated, megaloblastic cells in FL positive forγ-globin (FIGS. 6D and 6E). Morphologically these cells resembleprimitive cells that continue to circulate in substantial numbers duringthis period of gestation (McGrath, K. & Palis, J., 2008, Curr. Top. Dev.Biol. 82:1-22). Consistent with this interpretation, the numerousγ-globin positive cells seen in the circulation were all megaloblasticprimitive cells, whereas enucleate, smaller definitive cells wereuniformly negative (FIGS. 6E and 6F). To generalize these findings, theinventors performed similar immunohistochemical staining in otherindependently-derived lines of β-locus mice (FIGS. 6G and 6H) (Porcu, S.et al., 1997, Blood 90:4602-9). In all lines, γ-globin expression (asindicated by positive IHC) was confined to circulating megaloblasticcells that were infrequent in FL parenchyma. As similar observationshave been made in independently derived β-locus mice, the inventorsfindings demonstrate a characteristic feature of β-locus mice.

Single Cell Analysis Confirms the Divergent Behavior of Human β-GlobinLoci in Mice

To gain additional insight at the single cell level, the inventorsemployed primary transcript RNA fluorescence in situ hybridization(PT-FISH) to examine the relative expression of the endogenous mouse andhuman globin genes at different stages of ontogeny (Ragoczy, T., et al.,2006, Genes Dev. 20:1447-57; Trimborn, T., 1999, Genes Dev. 13:112-24).First, the inventors examined the relative expression of human γ- andβ-globin (with murine α-globin as a control) in E1 1.5 primitiveerythroid cells from two independent transgenic lines (A20 and A85).Consistent with prior analyses demonstrating high-level expression ofγ-globin at the primitive erythroid stage in β-locus mice, the inventorsnoted relatively high expression of γ-globin by PT-FISH, with low orabsent expression of human β-globin (FIGS. 7A and 2B). Among circulatingprimitive cells from a later stage of development (E13.5) a similarpattern was observed, although more human β-globin expression was seenand an overall reduction in the percentage of cells with a PT-FISHsignal (using the murine α-globin control) was noted, with only afraction of cells (˜⅓) showing transcriptionally active loci at a singletime point (FIGS. 7A and 7B). Examples of the cells used in thisanalysis are shown (data not shown). An interesting observation madewith concomitant PT-FISH analysis of human γ- and β-globin is the extentof cotranscription, which represents the concomitant presence of twoprimary transcript signals within the same gene locus (data not shown).

Analysis of Cotranscription by Primary Transcript Fluorescence In SituHybridization (PT-FISH) Analysis

Cotranscription is defined as the simultaneous presence of two primarytranscript signals from the same gene locus in a single cell. Highfrequency of cotranscription is seen in this analysis, particularly atstages when little of the mature γ-globin gene is expressed. In theperipheral blood cells (circulating primitive cells) from embryonic day13.5 (E13.5), 19 and 21% (in the A85 and A20 lines, respectively) ofcells expressing γ-globin show cotranscription of β-globin (data notshown). In the fetal liver cells from E13.5, this degree of overlapincreases dramatically, with 52 and 55% of cells expressing γ-globinshowing cotranscription of β-globin (data not shown). The nature of suchcotranscription is unclear. It has previously been ascribed to a rapidflip-flop mechanism of the locus control region (LCR) with thedownstream globin genes (Wijgerde, M., et al., 1995, Nature 377:209-13).The results suggest that primary transcripts may be generated bycotranscription even in the absence of robust transcription (asindicated for γ-globin in E13.5 FL cells). Since PT-FISH is limited to asingle snap-shot of transcription, it is unclear whether the rate oftranscription at cotranscribed loci is comparable. These findingssuggest that the rate and/or efficiency at these concomitantlytranscribed loci likely vary and therefore the presence of primarytranscripts, particularly in the context of cotranscription, may notindicate efficient production of mature transcripts.

Comparison of mouse embryonic εγ-globin with γ-globin revealed similarexpression of the mouse embryonic gene with human g-globin incirculating primitive cells from E13.5 (FIGS. 7C and 7D). This findingindicates that expression of the human γ-globin genes parallels that ofmouse embryonic β-like genes in the mouse trans-acting environment. FLcells from E13.5 were analyzed in a similar manner, by examining theexpression of mouse εγ and human γ-globin by PT-FISH in these cells.Only a low percentage of cells showed staining for either εγ or γ-globin(FIGS. 7C and 7D), compared with robust transcription of human β-globinat the same stage (FIGS. 7A and 7B). Consistent with prior developmentalanalyses in mice (Kingsley, P. D. et al., 2006, Blood, 107:1665-72;Trimborn, T., 1999, Genes Dev. 13:112-24), cells positive for mouse εγrepresent circulating primitive cells present within the mouse fetalliver. The cells that are positive for human γ-globin expression arealso likely to be primitive erythroid cells, and it is important torecognize that in these cells only a fraction (˜⅓) of loci are active atany single time point, thereby limiting the degree of concomitantexpression seen. Of note, 45 and 54% (in the A85 and A20 lines,respectively) of the primitive cells from E13.5 (PBC) with γ-globintranscript showed expression of εγ globin, supporting the notion thatγ-globin is treated as an embryonic gene in the mouse trans-actingenvironment. Interestingly, an early analysis of very low expressingtransgenes lacking critical locus region regulatory sequences hadsuggested that γ-globin indeed behaved as an embryonic gene, as we haveshown for mice containing the entire robustly expressed human β-locus(Chada, K., et al., 1986, Nature 319:685-9).

BCL11A Restricts Mouse Embryonic β-Like Globin Expression to thePrimitive Lineage

From these results it was concluded that the homologous mouse erythroidtrans-acting environment differs from that of the human, presumably withrespect to the composition or regulation of critical transcriptionalregulators. It has recently been shown that the gene BCL11A, whichharbors genetic variants that affect HbF levels in humans (Uda, M. etal., 2008, Proc. Natl. Acad. Sci. U.S.A. 105:1620-5; Lettre, G. et al.,2008, Proc. Natl. Acad. Sci. U.S.A. 105:11869-74; Menzel, S. et al.,2007, Nat. Genet. 39:1197-9; Sedgewick, A. E. et al., 2008, Blood CellsMol. Dis. 41:255-8), encodes a developmental stage-specific repressor ofthe human γ-globin genes (Sankaran, V. G. et al., 2008, Science322:1839-42). The prior findings were confined to an analysis of humanerythroid cells, where we found that forms of full-length BCL11A wereexpressed robustly in adult bone marrow erythroblasts, at substantiallylower levels in FL, and absent within primitive erythroblasts. Moreover,shorter variant forms of BCL11A are expressed in human primitive and FLerythroblasts, both of which express γ-globin. To investigate potentialspecies differences in BCL11A protein expression, we examinedstage-matched, FACS-sorted populations of mouse and human erythroidcells. Remarkably, comparison of BCL11A expression in mouse and humansamples reveal striking differences (FIG. 8A, FIG. 11). The expressionof BCL11A RNA measured by qRT-PCR in sorted stage-matched cellpopulations (sorted for CD71 and Ter-119) from different developmentalstages in mice demonstrates that BCL11A RNA is expressed at similarlevels in all definitive populations of murine cells, but was absent orexpressed at markedly reduced levels in primitive cells (normalized toGAPDH). First, BCL11A protein and RNA transcripts are absent inprimitive erythroid cells of mice. Second, full-length forms of BCL1 1Aare expressed at similar levels in definitive erythroid cells of bothmouse FL and bone marrow, whereas no shorter variant forms could beidentified in mice (FIG. 8A). Additionally, short variant forms arepresent at these earlier developmental stages. All human cells weresorted for CD235 and CD71 expression. In contrast, in murine cells,full-length BCL1 1A protein expression is evident in all definitiveprogenitor populations, including sorted stage-matched E13.5 fetal liverand bone marrow erythroid cells (all populations were sorted forTer119+/CD71+). No expression of BCL11A within murine primitive cellpopulations was detected. These results highlight important interspeciesdifferences that could potentially play a role in mediating divergentglobin gene regulation. A model based upon our findings of thedevelopmental expression of the β-like globin genes in humans, mice, andβ-locus mice is shown, along with a summary of BCL11A expression inthese two species (FIG. 8B).

The inventors demonstrated that expression of the human γ-globin genesstrictly parallels that of the mouse embryonic genes, εγ and βh1, in thecontext of the mouse trans-acting environment. Moreover, the pattern ofBCL1 1A expression suggests a role throughout definitive erythropoiesisin mice, as opposed to its predominant role after birth in humans. Thusit was hypothesize that changes in expression of BCL11A may beresponsible, at least in part, for the observed interspecies divergentexpression of β-like globin genes. To test directly a potential role forBCL11A in silencing the endogenous embryonic genes in the definitiveerythroid lineage, BCL11A knockout mice was examined. As describedpreviously (Liu, P. et al. 2003, Nat. Immunol. 4:525-32), BCL11A−/− micedie in the perinatal period from unknown causes. BCL11A−/− mice at E14.5and E18.5 during gestation were examined when robust definitiveerythropoiesis is taking place within the FL (FIG. 12). By phenotypicand morphologic approaches (Sankaran, V. G. et al., 2008, Genes Dev.22:463-475; Zhang, J., et al., 2003, Blood, 102:3938-46), erythropoiesisappeared ostensibly normal within these embryos (FIG. 9A, FIGS. 13-15).Then, the expression of the mouse globin genes was assessed. In strongsupport of the inventors' hypothesis, it was observed that silencing ofexpression of mouse embryonic globin genes fails to occur in E14.5 andE18.5 FL erythroid cells (FIG. 9B-E, FIG. 16). Restriction of embryonicglobin expression to the primitive lineage is lost. Expression of the εγand βh1 globin genes was up-regulated by 70 and 350-fold, respectively,at E14.5 (FIG. 9B). Together these embryonic globin genes account for 50percent of the total β-like globin genes at this stage, compared with0.4 percent in the controls. At E18.5, while the contribution of theirtranscripts to total β-like globin transcripts was somewhat reduced, εγand βh1 globin transcripts were 2600 and 7600-fold elevated compared tocontrols (FIG. 9C). To determine the cellular distribution of the mouseembryonic globins, immunohistochemistry was performed. Using thisapproach, we found that βh1 and εγ globins were robustly expressed indefinitive erythroid cells (FIGS. 9D and 9E, FIG. 17), whereas normallythese embryonic globins are confined to the primitive erythroid lineage(McGrath, K. & Palis, J., 2008, Curr. Top. Dev. Biol. 82:1-22) (FIG.8B).

Silencing of Human γ-Globin Expression Depends on BCL11A

We then examined the consequence of BCL1 1A loss on regulation of humanglobin genes in the β-locus mice. By introducing the β-locus transgeneinto the knockout environment, we found that in the absence of BCL1 1Adevelopmental silencing of the γ-globin genes is markedly impaired inthe definitive erythroid lineage (FIG. 9F, FIG. 18). In BCL11A−/−, +/−,and littermate control mice γ-globin RNA comprised 76, 20, and 0.24percent of total β-like globin gene RNA at E18.5, respectively (FIG. 9F,FIG. 18). Relaxation of γ-globin gene silencing in BCL11A+/−heterozygotes is consistent with the genetic association of BCL1 1A andHbF levels and extends our prior observations using knockdown approachesin human cells (Sankaran, V. G. et al., 2008, Science 322:1839-42) thattogether point to BCL11A as a quantitative regulator of γ-globinexpression. The failure of γ-globin gene silencing in the face ofotherwise ostensibly normal erythropoiesis provides compelling evidencethat BCL11A is a major regulator of the globin switches in mouse andhuman ontogeny.

In principle, BCL11A might influence globin gene expression eitherdirectly by interacting with cis-regulatory elements within the β-globincluster or indirectly by affecting cell cycle or other pathways thatultimately impinge on HbF expression. To discriminate thesepossibilities, chromatin immunoprecipitation (ChIP) was utilized tostudy primary human erythroid progenitors. Occupancy of neither the γ-or β-globin proximal promoters was detected. Rather, robust binding inseveral other regions of the β-globin cluster was observed (FIG. 19).These include the third hypersensitivity site (HS3) of the locus controlregion (LCR) (P. A. Navas et al., 1998, Mol. Cell. Biol. 18:4188), theregion of the high HbF-associated Corfu deletion upstream of theδ-globin gene (A. Bank, 2006, Blood 107:435), and another regiondownstream of the Aγ-globin gene that is commonly deleted in certainforms of hereditary persistence of fetal hemoglobin (A. Bank, 2006,Blood 107:435). Of particular note, all of these cis-elements have beensuggested to play a role in γ-globin silencing. The present resultsstrongly argue that BCL11A acts within the β-globin cluster. ShorterBCL11A variants present in cells that actively express γ-globin mayparticipate in others aspects of transcriptional regulation within theβ-globin cluster. Thus BCL11A, at different levels and in its variantforms, reconfigures the β-globin locus at different development stages.

CONCLUSION

Taken together, the findings here demonstrate how changes in expressionof a single transacting factor over the course of evolution may lead toaltered developmental gene expression. Shown herein is that cis-elementswithin the human β-globin locus are insufficient to recapitulate properdevelopmental regulation in a mouse context. Previously it has beenpostulated that the evolution of β-like globin gene expression islargely mediated through changes in cis-elements (Johnson, R. M. et al.2006, Proc. Natl. Acad. Sci., U.S.A. 103:3186-91). The findings hereinargue persuasively that changes in transacting factors may exertstriking effects on gene switching during development. BCL11A serves tosilence the embryonic genes in mouse definitive erythroid cells, incontrast to its role in humans where it acts to silence γ-globinexpression after birth. Moreover, we show that BCL11A is a powerfulregulator of the species divergent globin switches by demonstrating thatthe γ-globin gene escapes proper developmental silencing in a mousetransacting BCL11A−/− environment. The findings herein indicate a modelin which one (or more) trans-acting silencers of the embryonic globingenes, initially expressed throughout definitive erythropoiesis, havebeen altered during primate evolution, such that their expression isshifted to a later phase of definitive erythropoiesis, allowing for theevolution of a unique fetal hemoglobin expression stage. Here, it isshown that BCL11A represents one of the major factors regulating thisswitch. These findings allow for simplification of molecular modelsaccounting for this critical developmental transition. This workprovides not only unique insights into how alterations in geneexpression occur in the course of evolution, but also reveals additionalmechanistic clues to the clinically important fetal-to-adult hemoglobinswitch in humans.

We claim:
 1. A method for increasing fetal hemoglobin levels in a cell,the method comprising the steps of contacting a hematopoietic progenitorcell with an effective amount of a composition comprising an inhibitorof BCL11A, whereby fetal hemoglobin expression is increased in saidcell, or its progeny, relative to said cell prior to said contacting. 2.The method of claim 1, wherein the hematopoietic progenitor cell is acell of the erythroid lineage.
 3. The method of claim 1, wherein thehematopoietic progenitor cell is contacted ex vivo or in vitro.
 4. Themethod of claim 1, wherein the composition comprising an inhibitor ofBCL11A inhibits BCL11A expression.
 5. The method of claim 4, wherein theinhibitor of BCL11A expression is selected from a small molecule and anucleic acid.
 6. The method of claim 5, wherein the nucleic acid is aBCL11A specific RNA interference agent, or a vector encoding a BCL11Aspecific RNA interference agent.
 7. The method of claim 6, wherein saidRNA interference agent comprises one or more of the nucleotide sequencesof SEQ ID NO: 1-6.
 8. The method of claim 1, wherein the compositioncomprising an inhibitor of BCL11A inhibits BCL11A activity.
 9. Themethod of claim 8, wherein the inhibitor of BCL11A activity is selectedfrom the group consisting of an antibody against BCL11A or anantigen-binding fragment thereof, a small molecule, and a nucleic acid.10. The method of claim 9, wherein the nucleic acid is a BCL11A specificRNA interference agent, a vector encoding a RNA interference agent, oran aptamer that binds BCL11A.
 11. The method of claim 10, wherein saidRNA interference agent comprises one or more of the nucleotide sequencesof SEQ ID NO: 1-6.
 12. A method for increasing fetal hemoglobin levelsin a mammal in need thereof, the method comprising the step ofcontacting a hematopoietic progenitor cell in said mammal with aneffective amount of a composition comprising an inhibitor of BCL11A,whereby fetal hemoglobin expression is increased in said mammal,relative to expression prior to said contacting.
 13. The method of claim12, wherein said mammal has been diagnosed with a hemoglobinopathy. 14.The method of claim 13, wherein said hemoglobinopathy is aβ-hemoglobinopathy.
 15. The method of claim 13, wherein thehemoglobinopathy is sickle cell disease.
 16. The method of claim 13,wherein the hemoglobinopathy is β-thalassemia.
 17. The method of claim12, wherein the hematopoietic progenitor cell is contacted ex vivo or invitro, and said cell or its progeny is administered to said mammal. 18.The method of claim 12, wherein said contacting comprises contactingsaid cell with a composition comprising of an inhibitor of BCL11A and apharmaceutically acceptable carrier or diluent.
 19. The method of claim12, wherein the composition is administered by injection, infusion,instillation, or ingestion.
 20. The method of claim 12, wherein thecomposition comprising an inhibitor of BCL11A inhibits BCL11Aexpression.
 21. The method of claim 20, wherein the inhibitor of BCL11Aexpression is selected from a small molecule and a nucleic acid.
 22. Themethod of claim 21, wherein the nucleic acid is a BCL11A specific RNAinterference agent or a vector encoding a RNA interference agent, or anaptamer that binds BCL11A.
 23. The method of claim 22, wherein said RNAinterference agent comprises one or more of the nucleotide sequences ofSEQ ID NO: 1-6.
 24. The method of claim 12, wherein the compositioncomprising an inhibitor of BCL11A inhibits BCL11A activity.
 25. Themethod of claim 24, wherein the inhibitor of BCL11A activity is selectedfrom the group consisting of an antibody against BCL11A or anantigen-binding fragment thereof, a small molecule, and a nucleic acid.26. The method of claim 25, wherein the nucleic acid is a BCL11Aspecific RNA interference agent, a vector encoding said RNA interferenceagent, or an aptamer that binds BCL11A.
 27. The method of claim 26,wherein said RNA interference agent comprises one or more of thenucleotide sequences of SEQ ID NO: 1-6.
 28. A method for identifying amodulator of BCL11A activity or expression, the method comprisingcontacting a hematopoietic progenitor cell with a composition comprisinga test compound, and measuring the level of fetal hemoglobin or fetalhemoglobin mRNA in said cell or its progeny, wherein an increase infetal hemoglobin is indicative that said test compound is a candidateinhibitor of BCL11A activity or expression.
 29. The method of claim 28,wherein the hematopoietic progenitor cell is contacted in vivo, ex vivo,or in vitro.
 30. The method of claim 28, wherein the cell is of human,non-human primate, or mammalian origin.
 31. The method of claim 28,wherein the test compound is a small molecule, antibody or nucleic acid.32. The method of claim 28, wherein the composition causes an increasein fetal hemoglobin mRNA or protein expression.